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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 41.85%. 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. 45.82%
2. Medical Records and/or beneficiary testing logs do not meet the Glucose Monitors LCD (L33822)External Website requirements for billing over-utilization amounts. 22.97%
3. The documentation submitted is incomplete. 7.41%
4. The documentation does not contain a valid Standard Written Order (SWO). Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)External Website 6.63%
5. 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. 6.55%
6. The medical record documentation does not support the beneficiary has diabetes. Refer to National Coverage Determination 40.2External Website, Glucose Monitors LCD (L33822)External Website, and Policy Article A52464External Website. 1.97%
7. 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. 1.84%
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. 0.90%
9. The KS modifier was incorrectly appended. The medical record documentation supports the beneficiary is insulin treated. . Refer to Glucose Monitors LCD (L33822)External Website, and Policy Article A52464External Website. 0.86%
10. Payment for supplies billed above normal policy usage is being denied due to lack of documentation to support that they are reasonable and necessary. 0.82%

*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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