Oxygen and Oxygen Equipment Quarterly Results of TPE Review - JD DME
Oxygen and Oxygen Equipment 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) 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 40%.
Top Medical Necessity Denial Reasons
- Medical record documentation does not support the treating practitioner has ordered and evaluated the results of a qualifying blood gas study performed.
- Medical record documentation does not support any of the Group I criteria.
- Medical record documentation does not support a valid blood gas study obtained during exercise.
Top Technical Denial Reasons
- N/A
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.
