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Oxygen and Oxygen Equipment Pre-Pay Review Quarterly Status Report

Below is the analysis of claim denials for oxygen and oxygen equipment HCPCS codes E0424, E0439, E1390 and E1391 reviewed between April 1 and June 30, 2024. The error rate for this quarter is 17.30%. The top ten reasons for claim denials are as follows:

Rank Reason Percent
1. The medical record documentation does not support the treating practitioner has evaluated the results of a qualifying blood gas study performed. 36.91%
2. The medical record documentation does not include a blood gas study. 14.52%
3. The medical record documentation does not support any of the Group I criteria. 14.37%
4. The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. 11.20%
5. The standard written order (SWO) is missing a description of the item. 3.78%
6. The documentation does not have a valid SWO. 3.18%
7. There is not a valid handwritten or electronic signature by the author of the medical record. 3.03%
8. The medical record documentation does not support the blood gas study was obtained within two days prior to discharge from an inpatient hospital stay. 2.87%
9. The treating practitioner's order, Certificate of Medical Necessity, supplier prepared statement, or the practitioner's attestation, by itself, does not provide sufficient documentation of medical necessity. 1.97%
10. The supplier says they billed the items in error. 1.66%

*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 31, 2024

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