June 11, 2010
Oxygen Equipment Widespread Review: Notification of Continuation of Complex Review
NHIC conducted a widespread prepayment review on HCPCS E1390, E0431, and E0439.
E1390, (Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate)
E0431, (Portable gaseous oxygen system, rental; includes regulator, flowmeter, humidifier, cannula or mask and tubing)
E0439, (Stationary liquid oxygen system, rental includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask and tubing)
The results of the review were posted on NHIC web site on June 09, 2010. In the review, 376 claims were reviewed with 287 being denied; resulting in a 76.33% claim denial rate. Based on the outcome of the review, NHIC will continue with a widespread complex review on claims billed with HCPCS E0431, E1390 and E0439.
Suppliers are reminded they will receive an Additional Documentation Request (ADR) letter asking for specific information to determine if the item billed complies with the existing reasonable and necessary criteria. Failure to supply the requested information within 30 days of the date on the letter may result in claim denial.