CorporateBusiness Services
CGS Associates, LLC

October 21, 2008

Lessons Learned: Group 2 Support Surfaces

The CGS' Medical Review staff recently completed a widespread probe review of 193 randomly selected HCPCS code E0277 post payment claims. These claims were submitted by 40 suppliers and each supplier had 2-5 claims in the sample.

The widespread probe review was conducted because analysis of reports from the Comprehensive Error Rate Testing (CERT) contractor showed a high paid claims error rate for HCPCS code E0277. The CGS review confirmed CERT findings. While four suppliers had no denials, all the claims from twenty-two suppliers failed to meet one or more coverage criterion. The overall error rate was 72% with an identified overpayment of $77,574.07.

The following points are based on common problems identified by the probe review:

CGS Medical Review has developed a Documentation Checklist to aid suppliers in complying with documentation requirements regarding group 2 support surfaces. This checklist is available online at: http://www.cgsmedicare.com/jc/coverage/mr/PDF/MR_checklist_grp2_support_surfaces.pdf