National Government Services (NGS), the Jurisdiction B DME MAC, has started another widespread prepayment probe for Group 2 pressure-reducing support surfaces.
The affected HCPCS code is E0277.
In a news announcement about the new prepayment probe, NGS said it conducted a widespread prepayment probe for code E0277 in August and September of last year, and examined 285 claims during that action.
The claims error rate, NGS says, was 93 percent, with 108 claims being denied because providers did not respond to requests for additional documentation.
NGS added that the “primary reason” for denials was “insufficient medical record documentation to establish the need for Group 2 support surfaces.”
The second most common reason for denials was a lack of documentation to confirm the continued medical need for a Group 2 support surface.
The new prepayment probe is running from April through June.
“Supplier claims that are randomly selected will receive an ADR (additional documentation request) letter in the mail,” NGS said in a news announcement about the new probe. “The requested documentation must be returned by 45 days from the date on the letter or the claim will be denied as not medically necessary.”
Documentation needed to confirm medical necessity, NGS says, includes
a copy of the detailed written order signed and dated by the treating physician; a copy of the medical records that contain information supporting the initial medical necessity of the pressure reducing support surface ordered and a clear and complete evaluation of a patient’s wound(s); for claims other than the initial month, a copy of the medical records that contain information supporting the continued medical necessity of the support surface; and proof of delivery.
