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David McGill Blogger

Walking to Nowhere in Region D

Posted by David McGill | May 14, 2014

MAC Region D has published the latest prepayment claim review results for K3 prosthetic feet. For the second time this year, the MAC looked at L5981. Here are the key findings:

  • Overall, the reviewed claims had a 93% denial rate (26 of 28);
  • The MAC identified 4 main reasons for denial:
    • claim documentation didn't support the functional level;
    • claim documentation didn't demonstrate that the patient would reach or maintain K3 functional level status within a reasonable period of time;
    • inadequate proof of medical necessity;
    • claims lacked physician documentation corroborating the prosthetist's findings.

What does this mean for you?

Based on these results, the MAC announced that it will continue its Prepayment Service Specific Review. For those of you in Region D, this means that your L5981 claims specifically and K3 foot claims more generally will continue to trigger MAC scrutiny via prepayment claim review. 

If you're unsure whether your K3 foot claims satisfy Medicare's requirements, don't forget that Ossur's strategic partner, The Audit Team, can review your claim documentation before submission. For $175, The Audit Team's specialists provide a prompt and comprehensive assessment of your materials, identify any missing information, and organize all of your materials into an easy-to-use exhibit packet once it has verified that the claim satisfies all Medicare requirements. For more information about The Audit Team, click here.

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