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 between April 1 and June 30, 2024. The error rate for this quarter is 22.41%. The top four reasons for claim denials are as follows:
Rank | Reason | Percent |
---|---|---|
1. | Medical records do not support that the beneficiary requires frequent changes in body position and/or has an immediate need for a change in body position. | 50.00% |
2. | Medical records do not support that one of the four criteria for a fixed height hospital bed have been met. | 33.33% |
3. | The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. | 11.11% |
4. | The standard written order (SWO) is missing a description of the item. | 5.56% |
*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: July 29, 2024