Oxygen Quarterly Results of Targeted Probe and Educate Review - JA DME
Oxygen Quarterly Results of Targeted Probe and Educate Review
The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS codes E0424, E0431, E1390 and E1392. The quarterly edit effectiveness results from January 2024 - March 2024 are as follows:
Based on dollars, the overall claim potential improper payment rate is 54%.
Top Medical Necessity Denial Reasons
- Medical record documentation does not include a blood gas study.
- Medical record documentation does not support the blood gas study was obtained within two days of discharge from an inpatient hospital stay.
- Medical record documentation does not contain a qualifying blood gas study performed at rest (awake) or during exercise to support a portable oxygen system.
Top Technical Denial Reasons
- No medical record documentation was received.
Educational Resources
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Oxygen webpage to access coverage documents (Local Coverage Determination (LCD), Policy Article, National Coverage Determination (NCD)); documentation letters, forms, and checklists; reviews; tips; tools; resources; related articles; and educational events and tutorials, if applicable.
See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 information about probe/error validation reviews.
