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:
- Hospital Beds & Accessories – LCD (L33820)
- Hospital Beds & Accessories – Policy Article (A52508)
- Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)
- Supplier Manual Chapter 3 – Supplier Documentation
Updated: May 21, 2024