The Jurisdiction D, DME MAC, Medical Review Department is conducting a service specific review of HCPCS code(s) L1832 and L1843. The quarterly edit effectiveness results from January 2015 through April 2015 are as follows:
The L1832 review involved 89 claims, of which 89 were denied. Based on dollars, this resulted in an overall claim potential improper payment rate of 100%.
The L1843 review involved 93 claims, of which 92 were denied. Based on dollars, this resulted in an overall claim potential improper payment rate of 99%.
Top Denial Reasons
- The documentation does not justify the code selected for custom fitted versus off-the-shelf.
- The documentation does not support knee instability or that the beneficiary is ambulatory.
- No documentation was received in response to the Additional Documentation Request (ADR) letter.
- The Proof of Delivery (POD) is invalid.