NGS Reports Q2 Support Surfaces Review Results

National Government Services (NGS), Medicare’s Jurisdiction B DME MAC, has reported findings from its second-quarter widespread prepayment review on pressure-reducing support surfaces.

The medical review involved claims with HCPCS code E0277.

The DME MAC examined 190 claims between April 1 and June 30, 2015. Of those claims, 53 were allowed, while 137 were denied. That led to a claims error rate of 72.11 percent.

NGS said 20 claims were denied because it did not receive additional documentation from providers as requested.

The second-quarter denial rate was up compared to the 61.29-percent denial rate for the first quarter of 2015. The third-quarter 2014 denial rate was 80.3 percent, and the fourth-quarter denial rate was 81.2 percent.

Top denial reasons for the second quarter of this year, as reported by NGS, were insufficient documentation of large or multiple stage 3 or 4 pressure ulcers on the trunk or pelvis, and insufficient documentation of multiple stage 2 pressure ulcers on trunk or pelvis that hadn’t improved in the previous month.

Other common reasons for denials included the lack of a detailed written order before support surfaces were delivered, and no regular assessments by nurses, physicians or other licensed healthcare practitioners.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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