Changes to Medicare Hospital Payment 2007-2008

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ALERT

Things to Consider When Using NPWT

The Medicare DME MAC A Medical Review Department recently concluded three quarterly widespread reviews of E2402 from October 2008 through June 2009.

September 11, 2009
Results Of Widespread Prepayment Review
Of Claims For HCPCS Code E2402
(Negative Pressure Wound Therapy
Electrical Pump, Stationary Or Portable)

Results: 3rd Quarter 3rd 2008 (10/1/08 – 12/31/08)

twenty-nine (29) claims submitted by eight (8) suppliers
eight (8) claims denied (27.59%).

Results: 1st Quarter 2009 (1/1/09 – 3/31/09)

forty-five (45) claims submitted by thirteen (13) suppliers
eighteen (18) claims were denied (40%).

Results: 2nd Quarter 2009 (4/1/09 – 6/30/09)

eighty-one (81) claims submitted by twenty-four (24) suppliers
twenty-nine (29) were denied (35.80%).

The following are the most common reasons for denial:

The equipment was the same or similar to an equipment already being used
Patient eligibility (e.g., patient joined HMO)
Claim not payable under Jurisdiction A
No response to medical records request
The equipment was provided while the patient is in the nursing home
The equipment was considered not reasonable and necessary (e.g., no medical updates in patient's medical records, medical records lacking in subsequent wound assessment by the medical professional from the initial assessment of the wound, treatment notes by RN not signed.)

Association for the Advancement of Wound Care
866-AAWC-999
http://www.aawconline.org

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