The widespread prepayment probe for pressure-reducing support surfaces will continue in Medicare’s Jurisdiction B.
National Government Services (NGS) announced the results of reviews of Group II support surfaces, HCPCS coded E0277, for July and August 2012.
The products in question are powered, pressure-reducing mattresses, either alternating pressure, low air loss, or powered flotation without air loss. The July-August reviews involved 99 claims from multiple suppliers. The claims error rate was 83 percent, NGS reported.
In a news announcement of the results, NGS said, “The primary reason for denial was insufficient medical record documentation to establish the need for Group 2 support surfaces” — which applied to 50 of the claims.
“Insufficient medical record documentation denials were on many claims due to the failure to submit medical records to substantiate a comprehensive ulcer treatment program,” NGS added.
Invalid detailed written orders caused denials for 16 claims. Invalid proof of delivery was cited on 13 claims.
Given the high percentage of claims denials, NGS said it “will be continuing to review Group II support surface claims in the form of another widespread prepayment review and supplier-specific probes beginning in 2013.”
