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Jurisdiction B DME MAC Releases 3Q 2014 TLSO, LSO Prepayment Review Results

by The O&P EDGE
January 13, 2015
in News
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The Medical Review Department of National Government Services (NGS), the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC), released third quarter 2014 results of its prepayment review of thoracic-lumbar-sacral orthoses (TLSOs) and lumbar-sacral orthoses (LSOs), Healthcare Common Procedure Coding System (HCPCS) codes L-0450 through L-0640. Between July 1 and September 30, 2014, NGS performed a complex review of 553 claims, of which 532 were denied, resulting in a claim error rate of 96.2 percent. Of the claims, 122 were denied because documentation was not received in a timely manner.

The top denial reasons were as follows:

  • A detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary was not submitted.
  • No Pricing, Data Analysis, and Coding (PDAC) contractor verification.
  • No proof of delivery from the supplier.
  • No medical records were submitted.

Additional details about the reasons for a specific claims denial can be found through the Medical Review Denial Tool on the NGS website.

Related posts:

  1. The RACs Are Coming: Preparing for Medicare Claims Denials of O&P Care
  2. Academy Society Spotlight: Standing Postural Changes While Wearing a Lumbar Sacral Orthosis With Varying Degrees of Lordosis
  3. New Developments in O&P Medicare Claims and Other Matters
  4. DME MAC JA Posts Results of Prepayment Review for AFOs L-1940
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