Tag Archives: prepayment review

Results of Jurisdiction D Lower Limb Prostheses Prepayment Probe

More results from prepayment reviews of lower limb prostheses in Jurisdiction D DMEMAC Medical Review Department below. Based on the continued high error rate (79%)  on claims asociated with L5987, Noridian will close this prepayment probe and open a wide … Continue reading

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Quarterly Results of Prepayment Review of Spinal Orthoses

DMEMAC Jurisdiction D Medical Review Department released updated results on a widespread prepayment review program for spinal orthoses HCPCS codes, L0631 and L0637. The claims probed were from July 2013 – September 2013 and included a total of 2,112 claim … Continue reading

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Noridian Releases Results of Prepayment Review of L4360, L1970 and L1960

Jurisdiction D DME MAC has been conducting a wide ranging prepayment review of ankle/foot and knee/ankle orthosis HCPCS codes L4360, L1970 and L1960. Below is a summary of the results of the prepayment reviews for the first quarter of 2013. … Continue reading

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Widespread Review of Spinal Orthoses Brings 90% Denial on L0631 and L0637 Claims

Jurisdiction D DME MAC recently completed a widespread prepayment review of certain spinal orthoses, L0631 and L0637, due to an analysis compiled by CERT audit contractors.  The results are very troubling and will likely trigger more widespread reviews of the L codes … Continue reading

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Medicare RAC Prepayment Review Demonstration Begins August 27

The Medicare Recovery Audit Contractor (RAC) Prepayment Review Demonstration program, designed to reduce fraud and abuse in Medicare Part B claims, will begin reviewing claims documentation and medical necessity determinations in up to eleven states prior to issuing payment beginning August 27th, 2012.  The program was scheduled to … Continue reading

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Prepayment Review for O&P HCPCS Codes in Jurisdiction D

Following up on the Inspector General report from 2011, the following HCPCS codes were reviewed as part of a Comprehensive Error Rate Testing (CERT) analysis and have now been put on prepayment review for DME MAC Jurisdiction D.  L0631 – Lumbar-sacral … Continue reading

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New Prepayment Probe to Focus on High-Dollar DMEPOS

The Supreme Court met and released several more decisions this morning, but did not release the health care decision.  The court also announced Thursday would likely be the final day of the session, so the health care bill decision will … Continue reading

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