Medicare Audit: 82% Claim Denial Rate for LSO Braces

The DME MAC Jurisdiction A recently completed a widespread prepayment review of claims for Lumbar-Sacral Orthoses (HCPCS L0631 and L0637). These findings include claims processed primarily from December 2014 through February 2015. The review involved prepayment complex medical review of 1841 claims submitted by 322 suppliers. Responses to the Additional Documentation Request (ADR) were not received for 942 (51%) of the claims. For the remaining 899 claims, 157 claims were allowed and 742 denied resulting in a claim denial rate of 83%. The overall CDR was 82.0%. Based on review of the documentation, the following were the primary reasons for claim denials: claims had a missing or incomplete detailed written order, claims had medical record documentation issues, or claims had proof of delivery issues.

In sharp contrast, Meditech’s claim denial rate for Lumbar-Sacral Orthoses and its full line of products has consistently been in the 7-8% range. In response to these results, Meditech President Howie Bartz said, “We attribute Meditech’s success in this area to closely following Medicare LCDs (local coverage determinations), submitting proper documentation including medical necessity, and following up with our customers to ensure patient satisfaction. The process to appeal a denied claim can often be a long and arduous process and it’s important that we do all we can to ensure our end-users rarely experience claim denials. We’re extremely pleased that Meditech’s claim denial rate is significantly under the industry average.”

This recent industry claims review follows the 2014 survey conducted to assess overall patient satisfaction with Meditech’s LSO brace and its perceived effect on back pain and activity levels where the vast majority of patients experienced mild to moderate increases in activity level. “Overall, 96% of patients reported pain relief and 89% of patients reported an increase in activity level.” Bartz added, “Their self-assessments show the capacity for Meditech’s braces to improve quality of life for patients and contribute to customer satisfaction.”

The full news release may be accessed here:

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