In brief: Cigna ups ante on oxygen claims, Shelly Prial sounds off

Thursday, June 17, 2010

NASHVILLE, Tenn. - Providers in Jurisdiction C better have their documentation in order for oxygen concentrator claims. Cigna Government Services, the DME MAC for the jurisdiction, plans to implement a service-specific medical review edit for E1390, it announced in a listserv message last week. "This edit is the result of data demonstrating a high claims payment error rate for this product category," the message states. Claims subjected to this edit will be developed for additional documentation. Suppliers will be asked to submit documentation like detailed written orders and initial CMNs. Read the full listserv message at

Reps seek end to aggressive DME MACs

WASHINGTON - In a June 14 letter to CMS Acting Administrator Charlene Frizzera, Reps. Tammy Baldwin, D-Wis., and Bart Stupak, D-Mich., asked the agency to immediately end aggressive recoupment of Part B payments made for services "provided and billed in good faith by independent pharmacies." The DME MACs have sought repayment for the entire costs of supplies like diabetes test strips, going back as far as 2006. The issues stem from instances where patients with Part B coverage became Medicare Advantage (MA) or home health agency (HHA) patients prior in the middle of a prescription cycle. The letter asks that reconciliation payments be sought from the MA plans or the HHAs that "had access to up-to-date, correct coverage information.

Shelly Prial sounds off

ALPHARETTA, Ga. - Shelly Prial, a 60-year veteran of the home medical equipment industry and a Medtrade ambassador, has launched a blog that focuses on news updates and advice, Nielsen Expositions, owner and producer of Medtrade and Medtrade Spring, announced last week. "Every day, it seems that new difficulties make their appearance and there are different problems to resolve, but I want providers to know that they are not the only ones facing them," Prial stated in a release. "The purpose of the blog is to give all readers a place to ask questions and receive answers." Read the blog at