WASHINGTON—According to HHS’ Office of Inspector
General, in 2007, Medicare payments for Group 2 support surfaces
totaled $109 million, which accounted for 80 percent of all support
surface payments. But in the first half of that year, $33 million
of those payments were inappropriate, the OIG said.
In a report issued Aug. 5, the OIG said a review of Group 2 support
surface claims for the first six months of 2007 found 86 percent
either did not meet Medicare clinical coverage requirements (80
percent) or documentation requirements (33 percent).
“Over three-quarters of the claims that did not meet supplier
documentation requirements also did not meet Medicare's clinical
coverage requirements,” the report noted.
“Specifically, 38 percent of the claims were undocumented, 22
percent were medically unnecessary, 17 percent had insufficient
documentation and 3 percent had other billing errors. For the
claims that did not meet supplier documentation requirements, the
supplier delivered the support surface before obtaining the
physician order, the supplier did not have a physician order, the
supplier was missing the proof of delivery or the physician order
was not dated.”
Group 2 is the largest category of pressure-reducing support
surfaces.
The report, titled “Inappropriate Medicare Payments for
Pressure Reducing Support Surfaces,” said CMS should conduct
prepayment and postpayment reviews of claims for the products,
educate providers about coverage criteria for support surfaces,
monitor payments for Group 2 and collect any improperly paid funds
that were identified in its 2007 audit.
In addition, the report recommended that CMS review the use of the
KX modifier as a program safeguard. The KX, which is used to show
that a claim meets Medicare criteria and that adequate
documentation exists, “was not successful in flagging
inappropriate claims,” the report said.
CMS agreed with OIG's recommendations.
Read the full report at www.oig.hhs.gov/oei/reports/oei-02-07-00420.pdf.
