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David McGill Blogger

New Year, Same Issues in Region A

Posted by David McGill | January 23, 2014

MAC Region A has released the latest figures from its ongoing widespread prepayment complex review of K3 claims. Here are the key things you need to know:

  • The MAC focused on claims submitted between August and December, 2013.
  • 8% of the suppliers who received requests for additional documentation failed to respond at all.
  • Of the remaining claims, the MAC denied 58%.​
  • Of the denied claims
    • nearly 25% contained no medical record information;
    • 15.6% had clinical records that failed to satisfy the K3 functional level;
    • for 6% of the claims, prosthetists failed to submit their records; and
    • 5% had missing proof of delivery.

What does this mean for you?

Based on these results, Region A will continue its widespread prepayment review of K3 claims. In other words, the scrutiny of K3 claims will continue unchanged.

The MACs keep identifying the same issues resulting in denied claims, so we'll keep giving you the same advice to solve those problems: (1) make sure the physician's records corroborate yours; (2) use all the tools available to establish the patient's functional level, including video and validated tests (e.g., AMP PRO), and (3) make sure your delivery sheets contain all of the necessary elements required by Medicare.

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