Category: General Blog Posts

CMS Provides Clarification on Proof of Delivery and Signature Requirements

By Nancy Conant, RN Clinical Consultant Last month we told you about one of CMS’ newest initiatives, Patients over Paperwork. Started in December 2017, CMS plans to send out this newsletter on a regular basis, informing its readers about the progress being made on regulatory reform.  Through this initiative, CMS wants to place their focus on

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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

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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

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CMS roll out ‘Patients over Paperwork’

In October, CMS Administrator Seema Verma announced the “Patients over Paperwork” initiative, which is in accord with President Trump’s Executive Order that directs federal agencies to “cut the red tape” to reduce burdensome regulations. Through “Patients over Paperwork,” CMS established an internal process to evaluate and streamline regulations with a goal to reduce unnecessary burden, to increase efficiencies, and to

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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

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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:

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RAC AUDIT ALERT: Respiratory Assist Devices

On December 17, 2017, Performant Recovery, the National DMEPOS RAC, added Respiratory Assist Devices (RADs) to their approved issues list. According to their website, Performant Recovery will perform complex reviews of these claims to determine if coverage criteria and/or medical necessity requirements were met. Codes included in the audit are: E0470, E0471 Performant will review

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Same or Similar Denials: How to avoid it?

By Donna Youngblood, RN Same or similar denials occur when claims information is checked against the patient’s CMN history. This will indicate when equipment is “same or similar” to that piece of equipment being billed on the claim. An example of same and similar items includes a K0800 (power operated vehicle) and a K0823 (Group

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