National Government Services (NGS) will be implementing a widespread prepayment probe of claims filed for Group 2 pressure-reducing support surfaces, the Jurisdiction B DME MAC announced last week.
Claims for products coded E0277 are potentially affected. In widespread reviews, NGS said in a bulletin, “a random selection of submitted claims based on a particular service from multiple suppliers… are reviewed for medical necessity.”
E0277 support surfaces are officially defined as powered, pressure-reducing mattresses – alternating pressure, low air loss or powered flotation without low air loss – that have multiple characteristics, including an air pump that provides sequential inflation/deflation of the air cells; height of 5 inches or greater for the cells in which air is being circulated; a surface designed to reduce friction and shear for the patient; and a design created to provide patient lift, reduce pressure and prevent the mattress from bottoming out.
Suppliers whose claims are chosen for prepayment review will be notified via a letter and asked for documentation to support medical necessity. Documentation must be provided to NGS within 30 days of the date on the request letter, or the claim will be denied as not medically necessary.
Documentation requested by NGS includes a copy of the physician’s detailed written order, copies of medical records that substantiate the patient’s need for pressure-reducing support surfaces, and “clear and complete evaluation” of the patient’s pressure ulcers, including locations and sizes. DME suppliers must also provide proof of delivery and copies of Advance Beneficiary Notices of Noncoverage, if applicable.
