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Commodes Pre-Pay Review Quarterly Status Report

Below is the analysis of claim denials for commodes HCPCS codes E0163 and E0165 reviewed between April 1 and June 30, 2024. The error rate for this quarter is 32.89 %. The top nine reasons for claim denials are as follows:

Rank Reason Percent
1. The medical record documentation does not support that one of the three criteria have been met for a commode. 44.34%
2. The medical records received lack sufficient information concerning the beneficiary’s condition to determine if medical necessity coverage criteria were met. 26.24%
3. The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. 16.29%
4. The documentation does not have a valid Standard Written Order (SWO). 5.43%
5. There is not a valid handwritten or electronic signature by the author of the medical record. 2.26%
6. We did not receive any medical record documentation. 2.26%
7. The date on the medical record documentation is after the date of service. 0.90%
8. The documentation submitted is incomplete. 0.45%
9. This item or service is denied non-covered. 0.45%

*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: July 30, 2024

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