The fourth-quarter claims error rate for support-surface claims reviewed by National Government Services (NGS) rose slightly, the Jurisdiction B DME MAC has reported.
The 2014 quarter-four claims error rate for HCPCS code E0277 — defined as a powered pressure-reducing air mattress — was 81.2 percent, up from 80.3 percent for the third quarter, and 73.7 percent for quarter two.
From Oct. 1 through Dec. 31, 2014, NGS’s medical review department reviewed 292 claims, allowed 55 and denied 237.
Thirty-two claims were automatically denied because NGS reviewers did not receive the additional documentation that they requested.
NGS reported that the most common reasons for denial included insufficient documentation of large or multiple stage 3 or 4 pressure ulcers on the trunk or pelvis that hadn’t improved in the past month; missing signatures on medical documentation; and lack of detailed written orders prior to delivery.
