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DME Modifier KX Claims Require More Documentation

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  • In Audit
  • July 16, 2010
  • Comments Off on DME Modifier KX Claims Require More Documentation

An Office of Inspector General (OIG) review of jurisdiction C Medicare payments for selected Durable Medical Equipment, Prosthetics and Supply (DMEPOS) claims submitted in 2007 found that modifier KX Specific required documentation on file was not effective in ensuring required supporting documentation was on file. Based on the June 2010 review, the OIG estimates that Palmetto Government Benefits Administrators (Palmetto GBA) and CIGNA Government Services (CGS) inappropriately paid approximately $137 million to suppliers.
For certain DMEPOS, suppliers must use modifier KX on filed Medicare claims to indicate the claims meet Medicare coverage criteria and that the suppliers have the required documentation on file.
The types of missing documentation included:

  • proof of delivery,
  • physician’s order,
  • use or compliant use follow-up documentation, and
  • physician’s statement.

The errors, according to the OIG report, occurred because Palmetto GBA’s and CGS’ electronic edits were ineffective. What’s more, CGS added modifier KX to claims at the request of suppliers who said they had erroneously failed to add it to their claims.

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