NGS to Conduct Support Surfaces Prepayment Review

Review will check for medical necessity in selected claims.

National Government Services will conduct a widespread prepayment probe of claims for group 2 pressure-reducing support surfaces, the Jurisdiction B DME MAC has announced.

Powered, pressure-reducing mattresses - HCPCS code E0277 - are affected. The code includes alternating-pressure, low air loss and powered flotation mattresses without low air loss. The products included in the probe have, among other traits, "an air pump or blower which provides either sequential inflation and deflation of the air cells or a low interface pressure throughout the mattress," according to the July 30 NGS statement. The products in question also have "inflated cell height of the air cells through which air is being circulated is five inches or greater" and "a surface designed to reduce friction and shear."

In widespread reviews, a portion of the submitted claims for a certain product category - in this case, group 2 support surfaces -- is selected and examined for medical necessity.

The NGS notice said suppliers whose claims are selected for review will be "sent a documentation letter in the mail." Suppliers must return the requested documentation within 30 days, or their claims will be denied. Among the pieces of documentation demanded by the widespread review are a copy of the written order signed and dated by the physician, and a copy of medical records that verify the medical necessity for the support surface listed in the claim. For this particular review, that includes a "clear and complete evaluation of a patient's wound(s)," including the type/stage of the wound, its location, and documentation of the patient's treatment plan.

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