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:
- 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: November 5, 2024

