Hospital Beds Quarterly Results of TPE Review - JD DME
Hospital Beds Quarterly Results of Targeted Probe and Educate Review
The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) E0260 and E0295. The quarterly edit effectiveness results from July 2024 - September 2024 are as follows:
Based on dollars, the overall claim potential improper payment rate is 47%.
Top Medical Necessity Denial Reasons
- Medical record documentation does not support the beneficiary requires frequent changes in body position and/or has an immediate need for a change in body position.
- Medical record documentation does not support the beneficiary has a medical condition which requires positioning of the body in ways not feasible with an ordinary bed, requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain, requires the head of the bed to be elevated more than 30 degrees, or requires traction equipment which can only be attached to a hospital bed.
Top Technical Denial Reasons
- Payment for this item(s) is included in the payment of another as it bundles.
- The standard written order (SWO) does not identify the item to be ordered. Refer to 42 CFR 410.38(d)(1) and Standard Documentation Requirements A55426.
Educational Resources
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Hospital Beds 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.
