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:
- Medicare Minute MD℠ Oxygen and Oxygen Equipment
- Oxygen and Oxygen Equipment: Beneficiaries Meeting Group I & II Criteria – Documentation Checklist
- Oxygen and Oxygen Equipment – LCD (L33797)
- Oxygen and Oxygen Equipment – Policy Article (A52514)
- Oxygen Medical Review Resources
- Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)
- Supplier Manual Chapter 3 – Supplier Documentation
Updated: July 31, 2024