Category: DME

The value of prescreen review prior to a Medicare Request for Prior Authorization

By Kim Turner, RN, Clinical Consultant and Lisa Eick, RN, Clinical Consultant If you provide complex rehabilitative equipment to Medicare beneficiaries, you are likely familiar with the Medicare Prior Authorization Requests program for the K0856 (Group 3 standard, single power option) and the K0861 (Group 3 standard multiple power option) wheelchairs. The program began for

Read the full article »

Big Win for the O & P Industry

On Friday, February 9, 2018, it was announced that legislation was passed that CMS will now consider othotists and prosthetists notes as part of the patient’s medical record. Specifically, 13 Section 1834(h) of the Social Security Act (42 U.S.C. 1395m (h)) has been amended by adding at the end the following new paragraph: ‘‘(5) DOCUMENTATION

Read the full article »

The Value of MAC Online Tools

By Lisa Eick, RN – Clinical Consultant Navigating the sea of Medicare requirements for DME suppliers is often overwhelming for even the most seasoned suppliers. In an effort to ensure suppliers have access to non-complex information CMS mandates the contractors have a method for suppliers to easily access the information. These valuable tools can alleviate

Read the full article »

OIG Announces reviews on OTS orthotic devices

As part of the Office of the Inspector General’s (OIG) ongoing work plan efforts, off-the-shelf (OTS) orthotic devices were added to the active work plan items list last week. The OIG announced that, since 2014, claims for three OTS orthotic devices (L0648, L0650, and L1833) have grown by 97 percent and allowed charges have grown by

Read the full article »

Good Documentation Resolutions for 2018

By Kay Ellen Koch, OTR/L, ATP, RESNA fellow, Rehab Clinical and Education Consultant At the beginning of the New Year most of us make resolutions. Whether it is for health, exercise, fiscal or general life improvements, resolutions can be good for us. Resolutions for documentation can be beneficial too. No matter if it is a requirement or

Read the full article »

RAC AUDIT ALERT: VENTILATORS SUBJECT TO DWO REQUIREMENTS

On January 11, 2018, Performant Recovery, the National DMEPOS RAC, added ventilators to their approved issues list. According to their website, Performant Recovery will perform complex reviews on ventilator claims subject to DWO requirements on or after January 1, 2016 to determine if coverage criteria and/or medical necessity requirements were met. Codes included in the audit:

Read the full article »

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

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 »

CGS to begin claim adjustments to reflect competitive bid rates in non-CBAs

CGS announced yesterday that they will begin mass claims adjustments to reflect the revised 2016 DMEPOS fee schedule amounts for certain DME items furnished on or after January 1, 2016, in areas that are not competitive bid areas, based on information from competitive bidding programs for DME. CGS will adjust 40,000 claims each day for 24

Read the full article »

Improvements to the Adjudication Process of Serial Claims

A major win for DME Suppliers was announced yesterday, as CMS released information regarding improvements to the adjudication process of serial claims. Effective April 7, 2017, CMS has implemented changes to improve the processing and adjudication of recurring (monthly) claims for capped rental and certain inexpensive and routinely purchased (IRP) items. Prior to April 2017,

Read the full article »