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:
- Commode Chairs Online Education Course
- Commodes Documentation Checklist
- Commodes – LCD (L33736)
- Commodes – Policy Article (A52461)
- Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)
- Supplier Manual Chapter 3 – Supplier Documentation
Updated: May 21, 2024