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Commodes Pre-Pay Review Quarterly Status Report

Below is the analysis of claim denials for commodes HCPCS codes E0163 and E0165 reviewed between January 1 and March 31, 2024. The error rate for this quarter is 32.98%. The top 10 reasons for claim denials are as follows:

Rank Reason Percent
1. The medical record documentation does not support that one of the three criteria have been met for a commode. 50.00%
2. The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. 15.03%
3. The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met. 14.69%
4. The documentation does not have a valid Standard Written Order (SWO). 6.64%
5. There is not a valid handwritten or electronic signature by the author of the medical record. 3.50%
6. We did not receive any medical record documentation. 2.80%
7. The supplier indicates the item(s) were billed in error. 1.40%
8. The SWO is missing a description of the item. 1.40%
9. The date on the medical record documentation is after the date of service. 1.05%
10. The claim is a duplicate. 1.05%

*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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