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Hospital Beds Pre-Pay Review Quarterly Status Report

Below is the analysis of claim denials for hospital beds HCPCS codes E0260, E0261, and E0303 reviewed between January 1 and March 31, 2024. The error rate for this quarter is 15%. The top three reasons for claim denials are as follows:

Rank Reason Percent
1. The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. 71.43%
2. Medical records do not support that the beneficiary meets one of the four criteria for a fixed height hospital bed. 14.29%
3. Medical records do not support that the beneficiary needs frequent changes in body position and/or has an immediate need for a change in body position. 14.29%

*The total percentage will be greater than 100% because some claims denied for multiple reasons.

**The error rate included is an overall average for the supplier specific reviews as a part of the Targeted Probe and Educate program. This is not meant to be an overall error rate for the HCPCS code or policy under medical record review.

Resources:

Updated: May 21, 2024

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