National Government Services (NGS), the Jurisdiction B DME MAC, said it found a high claims error rate during a two-month widespread prepayment probe of claims for Group 2 pressure-reducing support surfaces and related accessories.
The support surfaces subject to the prepayment probe were HCPCS coded E0277.
NGS reviewed 285 claims during August and September 2011 and reported a 93-percent claims error rate.
Of the 285 claims reviewed, 108 were denied because NGS received no additional documentation in response to its request.
Another common reason for denial, NGS said, was “insufficient medical record documentation to establish the need for the Group 2 support surface, followed by the lack of documentation that supported the continued medical necessity for a Group 2 support surface.”
NGS said other reasons for denials included invalid physician orders, invalid proof of delivery, a lack of documentation for a comprehensive ulcer treatment program that included use of a Group 1 support surface prior to the order for a Group 2 support surface, and a beneficiary medical condition that didn’t meet coverage criteria for the Group 2 support surface.
