Oxygen and Oxygen Equipment Pre-Pay Review Quarterly Status Report
Below is the analysis of claim denials for oxygen and oxygen equipment HCPCS codes E0424, E0439, E1390 and E1391 reviewed between January 1 and March 31, 2024. The error rate for this quarter is 32.80%. 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. | 47.37% |
2. | The medical record documentation does not support any of the Group I criteria. | 14.17% |
3. | The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. | 6.14% |
4. | The medical record documentation does not include a blood gas study. | 5.85% |
5. | The documentation does not have a valid Standard Written Order (SWO). | 4.96% |
6. | The SWO is missing a description of the item. | 3.96% |
7. | The medical record documentation does not support the blood gas study was obtained within two days prior to discharge from an inpatient hospital stay. | 3.67% |
8. | The treating practitioner's order, supplier prepared statement, or the practitioner's attestation, by itself, does not show sufficient documentation of medical necessity. | 3.57% |
9. | The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met. | 2.87% |
10. | The medical record documentation does not support that the qualifying blood gas study was performed at the time of need. | 1.88% |
*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:
- 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: May 21, 2024