Funding Update: TriCenturion Releases 1st Quarter K0823

Power Chair Review Results

TriCenturion, the Jurisdiction A/B DME Program Safeguard Contractor, announced that during the first quarter of its widespread pre-payment review, it denied 89.75 percent of K0823 power chair claims in Jurisdiction A and 88.73 percent of K0823 claims in Jurisdiction B.

The review followed an initial widespread pre-payment probe in those same jurisdictions earlier this year.

Due to the high percentage of claims denials, TriCenturion said the review would continue.

Among the leading reasons for the denials, TriCenturion said, was failure to address functional limitations in the face-to-face evaluation; missing elements on the physician order; failure to indicate the physician visit was for a mobility examination; substituting supplier-created forms for the medical records; and lack of date stamp or equivalent to verify the supplier had received the physician order within 45 days.

To learn more about the continuing review, call the Jurisdiction A DME MAC (NHIC Corp.) at (781) 741-3950, or Jurisdiction B DME MAC (NGS) at (800) 338-6101.

This article originally appeared in the January 2008 issue of HME Business.

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