Completion of Prepayment Service Specific Complex Review Radiology Services: February 11, 2011 through April 11, 2011 Results

Palmetto GBA J1 Part B Medical Review has completed the service specific complex review for radiology services (CPT codes 71010 and 71020) for February 11, 2011, through April 11, 2011, in southern California. There were 19,001 claims reviewed, out of which 8,879 claims were denied. This was a 46.3 percent charge denial rate. The top denial reasons identified from the review are: • 47 percent: Missing Physician order • 27 percent: Missing or incomplete documentation for this date of service definition • 9 percent: Missing radiology report • 7 percent: Incorrect/incomplete/illegible patient identification or date of service Due to a moderate charge denial rate in southern California, CPT codes 71010 and 71020 will be reviewed for another quarter. At the end of the next quarter, a new charge denial rate will be calculated based on claims reviewed and processed. Medicare Part A and Part B MAC for Jurisdiction 11; comprised of North Carolina, South Carolina, Virginia and West Virginia. Medicare Part A and Part B MAC for Jurisdiction 1; comprised of California, Hawaii and Nevada. They are also the Ohio Part B Carrier.