Top denial/partial denial reasons and high-level results are listed below from each round of JH and JL Epidural Steroid Injections TPE reviews that have been conducted thus far by our medical review. If you have questions about your individual results, please contact the nurse reviewer assigned to your review for additional information. Additional rounds of review will be utilized when the targeted topic demonstrates a continued need for review with newly identified providers.
The most common reasons for denial or partial denials are the following:
Medical necessity - Documentation submitted for review was lacking evidence of medical necessity for the following reasons:
Documentation was lacking evidence to support local coverage requirements.
Insufficient documentation - Documentation submitted for review was insufficient to support the services billed to Medicare. Medical Review makes multiple attempts to correct these error types before completion of the review. Below are the top denial reasons for insufficient documentation that we were not able to resolve:
No response to additional documentation requests (ADRs) - Documentation was not submitted in a timely manner to support the services billed to Medicare.
Documentation submitted did not support patient inability to tolerate non-invasive conservative care.
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