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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 July 1 – September 30, 2024. The error rate for this quarter is 12.92%%. The top 10 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. 37.05%
2. The medical record documentation does not include a blood gas study. 15.60%
3. The medical record documentation does not support any of the Group I criteria. 15.32%
4. The documentation does not have a valid order. 7.80%
5. The medical record documentation does not support the blood gas study was obtained within two days prior to discharge from an inpatient hospital stay. 4.74%
6. The standard written order is missing a description of the item. 3.90%
7. The medical record documentation does not support that the qualifying blood gas study was performed at the time of need. 3.34%
8. The supplier billed in error. 3.06%
9. No medical record documentation was received. 2.51%
10. The patient was in an acute care hospital or skilled nursing facility on this date of service. 1.67%

*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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