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 January 2025 – March 2025 are as follows:
Based on dollars, the overall claim potential improper payment rate is 35%.
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.
Top Technical Denial Reasons
- Related item denied: Unbundling
- Beneficiary was in an acute care hospital or skilled nursing facility on this date of service.
- Item was provided during an inpatient hospital or Part A covered skilled nursing facility stay prior to the day of discharge and the use began during the stay.
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.
