About 86% of Medicare claims for certain support surfaces used to treat and prevent pressure ulcers did not meet coverage criteria in the first half of 2007. That resulted in millions of dollars in overpayments during that period, according to a new report from the Department of Health and Human Services Office of the Inspector General.
All told, Medicare overpaid for “group 2” support surfaces by roughly $33 million, according to the OIG report. Multiple types of errors were made in processing the claims, the report shows. A total of 80% of claims did not meet coverage criteria, while 38% of claims were undocumented. As many as 22% of the claims for group 2 support surfaces were not medically necessary, according to the OIG, with some claims showing that wounds had either already healed or had not presented yet at the time of the claim. Those claims accounted for $8.9 million in inappropriate payments.
Taken together, the results show that CMS’s current program safeguard activities are not sufficient and that additional steps are needed to reduce the high error rate for group 2 support surface claims, the report found. The OIG recommends additional pre- and post-payment reviews, continued education for suppliers and providers about coverage criteria for support surfaces, and additional analyses to monitor payments for group 2 support surfaces.
