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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:

Updated: May 21, 2024

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