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.
