SMRC adds PAP supplies to to-do list

Thursday, February 21, 2019

WASHINGTON – Noridian Healthcare Solutions, the Supplemental Medical Review Contractor, has added PAP supplies to its review list. The audit is a post-payment review of claims for dates of service from Jan. 1, 2017, through Dec. 31, 2017, according to a blog from the van Halem Group. The Office of Inspector General previously found that Medicare allowed replacement of PAP supplies more frequently than was reasonable and necessary; and that DME suppliers often did not have the required documentation. Documentation requirements that will be included in each AFR include: valid order for the PAP supplies and accessories billed; medical record documentation to support continued need; timely refill request documentation; proof of delivery; legible handwritten or valid electronic signature; and advance beneficiary notice of non-coverage, if applicable.