Jurisdiction B releases review results for support surfaces, CPAP devices

Friday, August 22, 2014

YARMOUTH, Maine – Group 2 pressure reducing support surfaces had a claims error rate of 73.7% from April 1, 2014, to June 30, 2014, the Jurisdiction B DME MAC has reported. Top denial reasons included insufficient documentation of larger or multiple stage III or stage IV pressure ulcers on trunk or pelvis that have not improved over the last month, and insufficient documentation due to a missing signature. CPAP devices had a claims error rate of 67% for the same timeframe, the MAC reported. Top denial reasons included no documentation that the beneficiary continues to use and benefit from the device for replacement following a five-year reasonable useful lifetime, and no documentation of a face-to-face evaluation by the treating physician for replacement.