NHIC Corp., the Jurisdiction A DME MAC, has released its third-quarter results for widespread prepayment reviews of standard power chairs.
The claims being reviewed were for HCPCS code K0823: group 2 standard power chairs with captain’s seating and weight capacities up to and including 300 lbs.
From July 1 through Sept. 30, 2012, NHIC said in a news announcement that the charge denial rate was 72.4 percent. In the third quarter of last year, the DME MAC examined 543 claims from 203 suppliers.
NHIC reported that 35 percent of claims were denied because they “were missing required clinical documentation and medical records to support medical necessity. These claims did not meet the coverage criteria outlined in the K0823 local coverage determination.”
In eight percent of denied claims, the face-to-face examination dates that were listed on the seven-element order did not match the dates of the face-to-face clinical evaluations.
Sixteen percent of denied claims had seven-element orders that were missing one or more of the required elements.
Detailed product descriptions were missing from 10 percent of denied claims, while an additional seven percent of denied claims had incomplete product descriptions. Thirteen percent of the denied claims had product descriptions that were dated before the physician’s signature on the seven-element order.
Ten percent of denied claims were missing evidence of a home assessment, NHIC said.
Additionally, NHIC said it did not receive additional documentation as requested for 20 percent of the claims it was reviewing.
