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 3.2.3.8. | 40.83% |
2. | Medical Records and/or beneficiary testing logs do not meet the Glucose Monitors LCD (L33822) 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). | 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). | 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 3.3.2.4. | 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), and Policy Article A52464. | 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), and Policy Article A52464. | 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:
- Blood Glucose Monitors Prepayment Edit Resources
- Glucose Monitors and Supplies Documentation Checklist
- Glucose Monitors – LCD (L33822)
- Glucose Monitors – Policy Article (A52464)
Updated: February 2, 2024