Medicare Audit Update – Results of Widespread Prepayment Review of Claims for L0631/L0637, Lumbar-Sacral Orthoses

The DME MAC Jurisdiction A has completed the widespread prepayment review of claims for Lumbar-Sacral Orthoses. This probe initiated due to errors identified by the Comprehensive Error Rate Testing (CERT) Contractor.

•    HCPCS code L0631 is a Lumbar-Sacral Orthoses, sagittal control with rigid anterior and posterior panels, posterior extends from sacroccoccygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment.
•    HCPCS code L0637 is a Lumbar-Sacral Orthoses, sagittal-cornal control with rigid anterior and posterior fram/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment. This probe was initiated due to errors identified by the Comprehensive Error Rate Testing (CERT) Contractor.

The review involved prepayment complex medical review of 2,166 claims submitted by 361 suppliers. These claims were reviewed from April 15, 2014 – August 28, 2014. Responses to the Additional Documentation Request (ADR) were not received for 887 (41%) of the claims. For the remaining 1,279 claims, 214 claims were allowed and 1,065 were denied resulting in a claim denial rate of 83%. The total denied allowance amount (dollar amount of allowable charges for services determined to be billed in error divided by the total allowance.

Full update here:
http://myemail.constantcontact.com/DME-MAC-A-News-for-October-30—2014—-Results-of-Widespread-Prepayment-Review-of-Claims-for-L0631-L0637—Lumbar-Sacral-Orthoses-.html?soid=1101306329206&aid=budeOVw5Gfo

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