Citing a significant improper payment rate to durable medical equipment (DME) suppliers, the Centers for Medicare & Medicaid Services (CMS) has issued Medicare Provider Compliance Tips for hospital beds and accessories.
The compliance information was in the July 9 edition of the MLN Connects newsletter.
“According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rate for hospital beds and accessories is 27.3%, with a projected improper payment amount of $16 million,” CMS said. “Insufficient documentation accounted for 82.6% of improper payments for hospital beds and accessories during the 2024 reporting period, while other errors (17.4%) also caused improper payments.”
CMS reminded suppliers that practitioners must “add documentation that the Medicare Administrative Contractor (MAC) medical staff may consider necessary, including medical records and practitioners’ reports that must prove the hospital bed’s medical necessity” because the beneficiary’s medical condition requires one of the following:
— Body positioning (e.g., to alleviate pain, promote good body alignment, prevent contractures, and avoid respiratory infections) in ways that aren’t workable in an ordinary bed;
— Special attachments not fixable to or used on an ordinary bed.
Additional documentation could be required to document medical necessity for a bed with variable-height features. One example could be “Severe arthritis and other injuries to lower extremities (for example, fractured hip),” CMS said. “The condition requires the variable height feature to help the patient place their feet on the floor while sitting on the edge of the bed.”
Variable-height features can also be appropriate for patients with “severe cardiac conditions … who must avoid the strain of ‘jumping’ up or down when transferring in and out of bed, and beneficiaries living with spinal cord injuries resulting in paraplegia or quadriplegia, loss of multiple limbs, or a history of stroke.
“We cover a variable-height hospital bed (HCPCS codes E0255, E0256, E0292 and E0293) if the patient meets one of the criteria for a fixed-height hospital bed and requires a bed height different from that of a fixed-height hospital bed to transfer to a chair, wheelchair or standing position,” CMS said.
The compliance tips also include coverage criteria for fixed-height hospital beds (E0250, E0251, E0290, E0291 and E0328); semi-electric powered hospital bed adjustments; and heavy-duty/extra heavy-duty hospital beds.
