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David McGill Blogger

Region D Clamps Down on K3 Feet

Posted by David McGill | March 12, 2014

MAC Region D has announced the results of a widespread prepayment probe review for claims involving code L5987. Here are the key points:

  • The claim error rate was 82%.
  • Region D generally reported 4 key issues resulting in claim denials:
    • Inadequate documentation supporting the billed functional level;
    • Inadequate documentation supporting the medical need for replacement;
    • Inadequate documentation proving that the beneficiary will reach or maintain a defined functional state within a reasonable period of time; and 
    • Failure to respond to Additional Documentation Requirements.

What does this mean for you?

First, as a result of the audit results, Region D announced that it would close the "probe review" and expand it into a widespread targeted review of L5987. So scrutiny of this code will continue.

Second, recent history shows that Region D has made the decision to target K3 feet. This is the 4th report since August 2013 focusing on either L5980, L5981, and now L5987. In none of them did the claim error rate drop below 80%.

Third, you can only overcome these denials by implementing strong documentation processes for every claim before you file it. How do you do this? (a) Check out our downloadable checklists in the Reimbursement Resources section on the left of this webpage. (b) Use our strategic partner, The Audit Team, to review your claims before submitting them to ensure compliance with Medicare's requirements. And (c) Use another of our strategic partners, GPM Consulting, to learn where your documentation processes break down and how to fix them.

For more information about The Audit Team and GPM Consulting, you can either contact your local Ossur Sales representative, or email us at reimbursement411@ossur.com.

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If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at reimbursement411@ossur.com