May 2018

TPE audit shows sharp decline in improper claim payment rate

An initial Target, Probe, and Educate (TPE) audit for Jurisdiction D conducted by Noridian Healthcare Solutions has found an improper claim payment rate of 19% for 4 HCPCS codes: L4360, L4361, L4386, and L4387. The codes relate to walking boot style orthoses. Previous improper payment rates for these codes have ranged from 66% to 100%. Noridian Healthcare Solutions serves as the Jurisdiction A and Jurisdiction D Durable Medical Equipment Medicare Administrative Contractor. The TPE program provides up to 3 rounds of audits with personalized provider education after each round designed to address the specific reasons for claim denial. The full report can be viewed at https://med.noridianmedicare.com/web/jddme/cert-review/mr/review-results/afo-kafo-quarterly-results-of-tpe-review.

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