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Blood Glucose Test Strips Pre-Pay Review Quarterly Status Report

Below is the analysis of claim denials for blood glucose test strips HCPCS code A4253 reviewed between October 1 and December 31, 2023. The error rate for this quarter is 38.31%. The top 10 reasons for claim denials are as follows:

Rank Reason Percent
1. No medical record documentation was received. Refer to Medicare Program Integrity Manual 100-08, Chapter 3, Section 3.2.3.8External PDF. 40.83%
2. Medical Records and/or beneficiary testing logs do not meet the Glucose Monitors LCD (L33822)External Website requirements for billing over-utilization amounts. 31.71%
3. Quantity of supplies ordered is above normal allowable amounts and no medical records were sent in to address the need for over-utilization. Medical records and a test log or narrative by the practitioner are required to support the requirements in the ‘high utilization' section of the Glucose Monitors LCD (L33822)External Website. 4.79%
4. Claim history shows that the supplier has already been paid for all or a portion of the medically necessary supplies for this time span. Therefore, the excess units are being denied. 3.67%
5. The documentation does not contain a valid Standard Written Order (SWO). Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)External Website. 3.31%
6. The medical record documentation is not authenticated (handwritten or electronic) by the author. Refer to Medicare Program Integrity Manual 100-08, Chapter 3, Section 3.3.2.4External PDF. 3.04%
7. Payment for supplies billed above normal policy usage is being denied due to lack of documentation to support that they are reasonable and necessary. 2.50%
8. The KX modifier was incorrectly appended. The medical record documentation supports the beneficiary is non-insulin treated. Refer to Glucose Monitors LCD (L33822)External Website, and Policy Article A52464External Website. 2.01%
9. The medical record documentation does not support the beneficiary has diabetes. Refer to National Coverage Determination 40.2, Glucose Monitors LCD (L33822)External Website, and Policy Article A52464External Website. 1.83%
10. The standard written order (SWO) is illegible. 1.25%

*The total percentage will be greater than 100% because some claims were denied for multiple reasons.

**The error rate included is an overall average for the supplier specific reviews as a part of the Targeted Probe and Educate program. This is not meant to represent an overall error rate for the HCPCS code or policy under medical record review.

Resources:

Updated: February 2, 2024

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