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Linda Collins Blogger

To be continued

Posted by Linda Collins | January 10, 2013

​The Jurisdiction A DME MAC Medical Review Department announced the results of a Widespread Prepayment Probe Review for Lower Limb Prostheses claims billed with a K3 modifier. The probe revealed a high percentage of claims errors due to lack of sufficient documentation, lack of functional level documentation, and missing proof of delivery.

The probe indicated the overall error rate continues to decline each quarter. However, the overall error rate for LLP remains high (66%+) so the prepayment reviews will continue for Jurisdiction A.

What can you do to prevent your claims from failing a MAC prepayment review? First and foremost, follow the guidelines outlined in the MACs’ LCD and Policy Article. Then remember the ABCs:

Assess the patient

  • Document the patient’s condition thoroughly
  • Use an objective functional level/mobility test to justify K level

Be in contact with the prescribing physician

  • Provide the physician with a letter of medical necessity
  • Provide the physician with a Detailed Written Order

Corroborate your records with the physician’s

  • Educate the prescribing physician about Medicare’s documentation requirements if the patient is a Medicare beneficiary
  • If necessary, provide the patient and/or physician with a copy of the “Dear Physician” letter from Medicare

Don’t forget to get proof of delivery

  • Have patient or patient’s representative sign and date form indicating exact products received

The full report, along with specific examples of claim documentation, is available at:

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