CMS revokes Arriva’s billing privileges

 - 
Tuesday, November 22, 2016

CORAL SPRINGS, Fla. – Arriva Medical’s contract for CMS’s national mail-order program for diabetes supplies is in question.

CMS has revoked Arriva’s billing privileges, alleging the provider submitted 211 claims for deceased patients between April 15, 2011, and April 25, 2016, according to a statement from parent company Alere.

“However, the CMS letter only identifies a sample of 47 such patients, upon which our review was based,” reads the statement. “The 211 claims allegedly at issues constitute approximately .00038% of Arriva’s nearly 5.8 million total claims during that period.”

Alere cites “CMS system challenges” as the problem. In August 2015, CMS “unilaterally” shut off Arriva’s access to the HIPAA Eligibility Tracking System, which is used to determine beneficiary eligibility, because the high volume of use by Arriva was crashing the system, according to Alere. That in turn, limited Arriva’s ability to verify eligibility.

With Arriva serving about one-half of the Medicare beneficiaries under the mail-order program, the move by CMS puts the future of the program at risk, states Alere. There are currently 11 mail-order contract suppliers listed on the Medicare supplier directory, down from about 18 in the previous round of the program.

This recent news is not the only hiccup between Arriva and CMS. In July, the company’s name disappeared from Medicare’s supplier directory, sparking rumors that its provider number had been revoked by the National Supplier Clearinghouse. On July 21, Alere said it was a misunderstanding and that matter had been cleared up.

Alere has stated that Arriva will continue to furnish covered services to beneficiaries until its case with CMS is resolved.