Audit Alerts

AuditAlertsOxygen Concentrators and Supplies
Strategic Health Solutions, the CMS Supplemental Medical Review Contractor (SMRC), has begun conducting post-payment claim reviews on oxygen supplies. The review includes claims for portable gaseous and stationary liquid oxygen system rentals, portable gaseous oxygen contents, single delivery port oxygen concentrators, portable oxygen concentrator rentals, and home compressor rentals used to fill portable oxygen cylinders.

Power Mobility Devices
Connolly Healthcare, the Recovery Audit Contractor (RAC) in Region C, is auditing claims for Power Mobility Devices (PMDs). Per the CMS Approved Issues log on Connolly’s website, “For any item to be covered by Medicare, it must meet all applicable Medicare statutory and regulatory requirements. We will review documentation to see if it supports the power mobility device claim.”

In July 2015, it was announced that CMS plans to release new Requests for Proposals for the next round of Recovery Auditor Contracts and the current RACs will continue auditing through at least December 2015. To determine if any of the DMEPOS you bill to Medicare is subject to a RAC audit, review your Region’s RAC website in the CMS approved issues section.

Non-Invasive Ventilators
The Medical Review department at CGS, Region C DME MAC, is currently conducting post-payment probe reviews for HCPCS code E0464. Specifically, CGS is reviewing the medical documentation submitted to indicate the ventilators were medically necessary, as indicated in the National Coverage Determination (NCD), Program Integrity Manual (IOM 100-08), Supplier Manual and Joint DME MAC Publication “Correct Coding of Ventilators”.

If you are experiencing audits and need assistance, please call
The van Halem Group – A Division of VGM Group, Inc.
101 Marietta St, NW  | Suite 1850  |  Atlanta, GA  30303
404.343.1815
www.vanhalemgroup.com