A widespread payment probe conducted by CIGNA Government Services’ Medical Review staff showed suppliers are not following published Medicare guidelines and policies in submitting claims for necessary and reasonable HCPCS code E0601 (continuous pressure airway device) services.

According to information posted by the Jurisdiction C DME MAC, the sample consisted of 100 randomly selected claims paid between October 1, 2009, and December 31, 2009. The claims were submitted by 96 different suppliers.

For 69 claims, the order did not include refill/replacement instructions. For 26 claims, the file did not include a clinical reevaluation conducted by the treating physician 31 to 91 days after initiating therapy. The DME MAC also listed other claim errors.

“[Overall] the calculated error rate (determined by dividing the dollar amount of services paid in error by the dollar amount of services medically reviewed) was 63.94%,” information posted by CIGNA stated. “The PAP policy group ranks #7 in Comprehensive Error Rate Testing (CERT) errors accounting for 3.8% of sample dollars paid in error.”