Oxygen and Oxygen Equipment Pre-Pay Review Quarterly Status Report
Below is the analysis of claim denials for oxygen HCPCS codes E0424, E0439, E1390 and E1391 reviewed July 1 – September 30, 2024. The error rate for this quarter is 16.27%. 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. | 27.35% |
2. | The medical record documentation does not support any of the Group I criteria. | 26.24% |
3. | The medical record documentation does not include a blood gas study. | 12.43% |
4. | The documentation does not have a valid standard written order. | 7.46% |
5. | The order is missing a description of the item. | 6.63% |
6. | The medical records lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met. | 3.59% |
7. | The medical record documentation does not have a blood gas study performed at rest or during exercise to support a portable oxygen system. | 3.31% |
8. | The supplier billed in error. | 3.04% |
9. | The medical record documentation does not support the blood gas study was obtained within two days prior to discharge from an inpatient hospital stay. | 2.76% |
10. | The documentation is incomplete. | 1.93% |
*The total percentage will be greater than 100% because some claims were 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: November 1, 2024