Tip From The Trenches

Date Published: August 22 2013

In NY, why are the prepayment audits for oxygen concentrators so frequent?

Insufficient documentation from the treating physician.

DME MAC A Medical Review has been performing a service-specific Documentation Compliance Review (DCR) of HCPCS Code E1390 (Oxygen Concentrator) claims.

The following findings are for claims reviewed from April 01, 2013 through June 30, 2013. The review involved DCRs of 5,401 claims:

- Of the 5,401 claims reviewed, 3,405 claims were denied resulting in a claim denial rate of 63%.

- An additional 85 claims were denied during this time frame because responses were not received for the Additional Documentation Requests (ADR).

Based on review of the documentation received, the following are the primary reasons for denial:

- No documentation of the treating physician visit 30 days prior to the Initial CMN was submitted.

- No documentation of the beneficiary’s most recent blood gas study/oxygen saturation test was submitted.

- Proof of delivery was not submitted or was incomplete.

SOURCE: Results of Documentation Compliance Review (DCR) of Claims for Oxygen Equipment, HCPS E1390, posted August 9, 2013. NHIC, Corp. A CMS Contractor and Durable Medical Equipment Medicare Administrative Contractor.

This information is brought to you by Tips from the Trenches, in response to FAQs from our customers. is a web-based software with up-to-date criteria for medical justification assisting HME providers obtaining and preparing documentation for payer sources. For more information, contact us at 

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