Cushions up for prepayment audit

Wednesday, January 15, 2014

NASHVILLE, Tenn. – CGS, the DME MAC for Jurisdiction C, will implement a prepayment edit for E2603 (skin protection wheelchair seat cushion, any depth, but less than 22 inches wide) and E2622 (adjustable skin protection wheelchair seat cushion, any depth, less than 22 inches wide). The contractor is conducting the edit because of high claims payment error rates for this product category, according to a Jan. 14 bulletin. For claims subjected to the edit, providers will need to provide delivery documentation; detailed product description (for motorized base) or written order (for manual base); medical records demonstrating need; and advanced beneficiary notice. Providers must file the additional documentation within 45 days of notification or the claim will be denied, according to the bulletin.