National Government Services, the Jurisdiction B DME Medicare
Administrative Contractor, has recently completed a widespread
prepay review of negative pressure wound therapy (HCPCS E2402) and
The review was initiated as the result of an overall continuing
disability review of 61 percent in the 2007 widespread probe of new
products added in the NPWT policy group.
The major reasons for claim denials were that no medical
records/orders from the physician regarding wound treatment were
received with the initial coverage criteria (i.e., nutritional
status, wound description, measurements and progress notes from the
nurse/wound clinician) prior to the initiation of the NPWT.
Fifty-one percent of the claims that were examined were denied
because Medicare policy criteria were not met. Of the claims that
- Information received for the date of service conflicted with
the original information of the date of service.
- Issues of the location, measurements and wound descriptions in
the medical record were conflicting and did not match.
To prevent denials of NPWT claims at your company, make sure the
medical documentation that is in your patient's medical record
meets the coverage criteria listed in the local coverage
determination (LCD) prior to billing. Review the physician orders
and progress notes carefully before your claims are submitted. It
is important to train billers and medical documentation personnel
to make certain they are familiar with documentation requirements
and proper billing protocols when processing NPWT claims.
Sarah Hanna is a reimbursement consultant and vice president of
ECS Billing & Consulting, Tiffin, Ohio, and specializes in
proper billing protocols, Medicare coverage guidelines and billing
office procedures. She can be contacted at 419/448-5332 or firstname.lastname@example.org.
Based on analysis of 5,617,383 claims adjudicated by the four
DME MACs and processed for RemitDATA customers from April-June,
2008. Source: RemitDATA, 866/885-2974, www.remitdata.com