NGS plans oxygen reviews, reports high PAP error rate

Friday, February 15, 2013

WASHINGTON – Due to ongoing high error rates, National Government Services (NGS), the Jurisdiction B DME MAC, plans a widespread prepayment medical review of claims for portable oxygen (E0431) and related equipment, it announced in a message this week. Providers can review the requirements at the NGS website. NGS also reported this week that about two thirds of claims for positive airway pressure devices (PAP) during the fourth quarter of 2012 were denied, according to a prepayment review. Of the 61 claims reviewed for E0601, 40 (68%) were denied. Some of the most common reasons for denial: no face-to-face evaluation, no documentation of instruction on the proper care and use of the device, and invalid detailed written order.