National Government Services (NGS), the Jurisdiction B DME MAC, has announced the 2014 quarter three results of its ongoing widespread prepayment review for HCPCS code E0277 – Group 2 pressure-reducing support surfaces.
During the July-through-September review, the DME MAC examined 274 claims. Ultimately, it allowed 54 claims and denied 220 claims, resulting in a claim error rate of 80.3 percent.
NGS indicated in a news announcement that 22 claims were denied because the DME MAC did not receive the additional documentation it had requested by its deadline.
The most common denial reasons according to the announcement included no use of a Group 1 support surface; insufficient documentation of large or multiple stage 3 or stage 4 pressure ulcers on the beneficiary’s trunk or pelvis that hadn’t improved in the last month; insufficient documentation of multiple stage 2 pressure ulcers on trunk or pelvis that hadn’t improved in the last month; missing signatures on medical documentation; and no care plans established by the physician or home care nurses.
The 80.3-percent claim denial rate was an increase from the 2014 quarter two (73.7 percent claim denial rate) and quarter one (72 percent claim denial rate) results.
