Prepare for the future – New Social Security Number Removal Initiative

By: Nancy Conant, Clinical Consultant Are you aware the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 mandates the removal of the SSN-based HICN from Medicare cards?  This is a huge undertaking as CMS has identified approximately 90 different stakeholder entities that receive, store, use, or provide the HICN today.  The reason for this

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UPDATE: Targeted Probe and Educate (TPE) Pilot

UPDATED: October 6, 2017 In October 2017, the TPE Pilot is now open to all four DME MAC Jurisdictions. Suppliers will be chosen based on the following criteria: Items that pose the greatest financial risk to the Medicare Trust Fund – HCPCS with high national error rates, high dollar equipment, etc. Individual suppliers with high

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Complex Rehab Technology and Manual Wheelchair Accessories:Help HR 3730 Get Passed

By – Kay Koch, OTR/L,ATP, RESNA Fellow Complex Rehab Technology (CRT) includes specialized wheelchairs, seating systems, and other adaptive equipment such as standing devices and gait trainers.  These individually configured products are used by people with high level disabilities such as ALS, cerebral palsy, multiple sclerosis, muscular dystrophy, spinal cord injury, and traumatic brain injury

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Audit Alert: CPAPs and Spinal Orthoses

On August 2, 2017, Performant Recovery, the National DMEPOS RAC, added Spinal Orthoses to their approved issues list. According to their website, Performant Recovery will perform complex reviews of these claims to determine if coverage criteria outlined in the Local Coverage Determination (LCD) for Spinal Orthoses was met. Performant will review medical documentation provided to

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ABN instructions – Special Guidance for Non-Participating Suppliers and Providers

CMS recently updated their ABN Form and accompanying instructions. For non-participating suppliers that issue an ABN for unassigned items/services you must do the following two things in order for the ABN to be considered a valid notice. First, in the Options: Blank (G), you must strike the last sentence in the Option 1 paragraph with a

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UPDATE: Targeted Probe and Educate (TPE) Pilot

UPDATED: October 6, 2017 In October 2017, the TPE Pilot is now open to all four DME MAC Jurisdictions. Suppliers will be chosen based on the following criteria: Items that pose the greatest financial risk to the Medicare Trust Fund – HCPCS with high national error rates, high dollar equipment, etc. Individual suppliers with high

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Audit Alert: AFO & KAFO Orthoses

On July 5, 2017, Performant Recovery, the National DMEPOS RAC, added AFO and KAFO orthoses to their approved issues list. According to their website, Performant Recovery will perform complex reviews of these claims to determine if basic coverage criteria outlined in the Local Coverage Determination (LCD) for AFO/KAFO Orthoses was met. Performant will review medical

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