NGS Announces Hospital Bed Widespread Prepayment Review

• By Laurie Watanabe
• Oct 15, 2014

National Government Services (NGS), the Jurisdiction B DME MAC, has announced it will be starting a widespread prepayment probe review for hospital beds.

The Oct. 9 announcement said the review will target four hospital bed HCPCS codes:

-- E0294 hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress

-- E0260 hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress

-- E0301 hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type of side rails, without mattress

-- E0303 hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress

NGS said the review was being launched because "Data analysis identified this area as having a high Comprehensive Error Rate Testing error rate."

As with other Medicare DME MAC prepayment reviews, affected providers will be sent Additional Documentation Requests (ADR). Information that providers forward to NGS should include the following, according to the DME MAC:

-- A copy of the Detailed Written Order (DWO) signed and dated by the treating physician. For items with initial Dates of Service (DOS) Jan. 1, 2014, the detailed written order must include the physician's NPI and be signed and dated by the physician prior to dispensing.

-- A dispensing order, if the DWO is signed and dated after the DOS for those items not requiring a written order prior to delivery (WOPD).

-- For all claims, a copy of the medical records that contain information that supports the initial coverage criteria has been met for medical necessity of the hospital bed ordered, and a clear and complete evaluation of the patient's condition according to the Local Coverage Determination (LCD).

-- For subsequent months' claims, a copy of the medical records that contain information supporting the continued medical necessity of the hospital bed.

-- Documentation of proof of delivery.

Providers should also submit an Advance Beneficiary Notice of Noncoverage (ABN), if they have one on file.