Medicare administrative contractor Palmetto conducted prepayment targeted probe and educate (TPE) reviews on extracapsular cataract removal with insertion of intraocular lens for July to September 2023.

A total of 239 claims were reviewed from surgeons in three states: Alabama, Georgia and Tennessee.

The overall claim denial rate was 48% for the three states, and claims from Georgia alone had a denial rate of 99%.

The top three denial reasons were:

• Palmetto deemed the information submitted did not support the medical necessity of the services billed per their local coverage determination (LCD) policy.
  
  
• Supporting documentation requested for a specific date of service was not received or was incomplete, resulting in Palmetto being unable to make a reasonable and necessary determination for the service billed.
  
  
• The documentation received contained incorrect, incomplete or illegible patient identification or date of service.

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