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Audit Alerts for DME MAC Jurisdiction D

Posted on in Billing/Reimbursement

From: The van Halem Group, A Division of VGM Group, Inc.

Noridian recently announced several service-specific, pre-payment reviews for suppliers billing to Jurisdiction D. Please see the list below to determine if the services you provide to beneficiaries in Jurisdiction D could be at risk for an audit.

Recently added:

  • TENS (E0730) – Potential improper payment rate of 98 percent.
  • External infusion pumps (E0781, E0784) -- Potential improper payment rates of 37 percent and 61 percent (documentation compliance review).

Codes that will remain on pre-payment review due to recently published improper payment rates:

  • Therapeutic shoes (A5500) - Improper payment rate of 76 percent.
  • Oxygen (HCPCS E0439, E0434) - Improper payment rate of 55 and 37 percent, respectively.
  • Hospital beds (HCPCS E0260) – Improper payment rate of 52 percent.
  • Ankle-foot/knee-ankle-foot orthosis (HCPCS L1960, L1970, L4360, L4361) - Improper payment rate of 73, 78, 98 and 73 percent, respectively.
  • Spinal orthoses (HCPCS L0648, L0650) - Improper payment rate of 99 and 98 percent, respectively.
  • Knee orthoses (HCPCS L1832, L1833, L1843) - Improper payment rate of 67, 92 and 83 percent, respectively.
  • Urological supplies (HCPCS A4351, A4353, A4358) - Improper payment rate of 50, 77 and 66 percent, respectively.
For complete details on these reviews, refer to the Noridian DME MAC Jurisdiction D website.

 

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