Category: RAC

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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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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Medicaid RACs are here

The Affordable Care Act mandated that States and territories establish RAC Programs. The CMS Final Rule, published September 16, 2011, required states to implement their Medicaid RAC programs, absent an exception, by January 1, 2012. Fast-forward to late 2016, and the DME Industry is finally starting to see the effects of this implementation. In recent

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