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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 July 1 – September 30, 2024. The error rate for this quarter is 27.05%. The top 9 reasons for claim denials are as follows:

Rank Reason Percent
1. 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. 41.51%
2. Medical records do not support that one of the 4 criteria for a fixed height hospital bed have been met. 28.30%
3. The standard written order is missing a description of the item. 11.32%
4. The supply or accessory is denied as the base equipment is denied. 5.66%
5. The beneficiary was in an acute care hospital or skilled nursing facility on this date of service.     3.77%
6. The medical records received lack sufficient information concerning the beneficiary’s condition to determine if medical necessity coverage criteria were met. 3.77%
7. Medical records do not support the beneficiary's weight is between 350 and 600 pounds and therefore qualifies for a heavy duty or extra wide hospital bed. 1.89%
8. The documentation is incomplete 1.89%
9. The supplier billed the item in error. 1.89%

*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: November 5, 2024

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