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Audit (A-04-11-04010)

Medical Services of America Did Not Always Have Required Documentation on File to Support Its Medicare Claims

Executive Summary

Medical Services of America (MSA) did not always have the specific required documentation on file to support the use of the KX modifier before submitting durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims to Medicare. MSA had the required documentation on file for 38 of the 100 sample claims; however, it did not have required documentation on file for the remaining 62 claims. Based on our sample results, we estimated that Medicare paid MSA $179,000 for unallowable claims that did not have the required documentation on file.

MSA's policies and procedures were not adequate to ensure that the required documentation was on file prior to billing Medicare for DMEPOS claims. Additionally, MSA's billing software is programmed to automatically attach the KX modifier to claims that require the modifier for payment.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201