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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 between January 1 and March 31, 2024. The error rate for this quarter is 35.79%. 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. 39.41%
2. The medical record documentation does not support any of the Group I criteria. 20.13%
3. The standard written order (SWO) is missing a description of the item. 8.05%
4. The medical record documentation does not include a blood gas study. 5.72%
5. The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. 5.30%
6. The documentation does not have a valid SWO. 4.03%
7. There is not a valid handwritten or electronic signature by the author of the medical record. 3.39%
8. The treating practitioner's order, supplier prepared statement, or the practitioner's attestation, by itself, does not provide sufficient documentation of medical necessity. 2.75%
9. The medical records lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met. 2.75%
10. The medical record documentation does not support the blood gas study was obtained within two days prior to discharge from an inpatient hospital stay. 2.12%

*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: May 21, 2024

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