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

Read the full article »

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

Read the full article »

Targeted Probe and Educate (TPE) Pilot: Friend or Foe?

In recent months, the CMS has been touting its new “provider friendly” approach, which is, in part, a way to decrease the ever-mounting appeals backlog. And they have introduced several initiatives to do just that, including limiting the scope of review of Redeterminations and Reconsiderations and adjusting serial claims found favorable in the appeals process.

Read the full article »

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

Read the full article »

New Brightree Tool Supports HME Industry Efforts to Collect Data on Medicare Audits

The next HME Audit Key data submission period, covering the time period through the 2nd Quarter of 2017, is set to open on July 17.  Even if you haven’t previously participated, you can still take part starting with this round.  HME suppliers of all sizes and specialties are encouraged to join this campaign to build

Read the full article »

Are you prepared for the new nationwide PAR?

By Kay Koch, OTR/L, ATP Rehab Clinical and Education Consultant Beginning July 17, 2017, K0856, single power option and K0861 multiple power options, Group 3 Power Mobility Devices will be subject to Prior Authorization Review (PAR) nationwide. Prior to this date, the PAR program has been in place since September 1, 2012 and included all POV and

Read the full article »

Correct Coding – Leg Rest and Foot Plates/Foot Platforms bundled into HCPCS E1012

By: Kay Koch, OTR/L, ATP, Rehab Clinical and Education Consultant This DME MAC Joint Publication was posted on June 22, 2017. It is a good reminder to those who are billing the E1012 center mount elevating leg rest on power wheelchairs. Recently it has come to the attention of the DME MACs that suppliers are billing separately for footplates

Read the full article »