The 2014 second-quarter Charge Denial Rate for Group 2 pressure-reducing support surfaces remained comparable to previous results, NHIC Corp. has reported.
The most recent report was for review period claims dated April 1 through June 30, 2014. NHIC, Medicare’s Jurisdiction A DME MAC, said 215 claims from 72 providers were involved in the review. NHIC did not receive additional documentation as requested for 47 of the claims under review.
NHIC allowed 48 of the remaining claims and denied the other 120. The total Charge Denial Rate for the quarter was 72.3 percent.
That compares to a 73.9 percent Charge Denial Rate for the first quarter of 2014, and a 72.3 percent Charge Denial Rate for the final quarter of 2013.
NHIC reported that the most common reason for denials involved failure to meet the coverage criteria for the HCPCS E0277 code.
The coverage criteria are as follows:
— The beneficiary has multiple stage II pressure ulcers located on the trunk or pelvis which have failed to improve over the past month, during which time the beneficiary has been on a comprehensive ulcer treatment program;
— Or the beneficiary has large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis;
— Or the beneficiary had a myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis within the past 60 days, and has been on a Group 2 or 3 support surface immediately prior to discharge from a hospital or nursing facility within the past 30 days.