Tag: Error Rate

BALTIMORE - The error rate reduction plans of Medicare claims administrator contractors are not always relevant to CERT results and vary substantially in number, according to a new report from the Office of Inspector General (OIG). CMS oversight of error rate reduction plans is limited and the staff that reviewed the plans may have been unable to determine whether the plans addressed their most recent CERT results, the OIG found. “Additionally, although some of the sampled plans did not include...

WASHINGTON - With error rates for power wheelchairs consistently hovering around 50%—or more—providers say it's time to bring technology into the equation.“I asked, 'Isn't there a better way?'” said Ron Manno, president of Sewell, N.J.-based HME company Core Care Technologies and CEO of software company Reliant Data Solutions. “The answer is yes, and it starts with going paperless.”Both Manno and Gary Cox, who recently sold his Glendale, Ariz.-based HME company...

WASHINGTON - CGS, the Jurisdiction D DME MAC, released an overview of its K0823 prepay review activity this month, and the results are ugly.From the second quarter of 2012 to the second quarter of 2013, the denial rate rose steadily until hitting a peak of 69%. The denial rate fell to 54% for the third quarter of 2013—not much better.These rates transcend jurisdictions, stakeholders say, and are especially troubling considering all of the other pressures that HME providers face in today's market.“No...

MOUNT VERNON, N.Y. - Landauer Metropolitan Inc. (LMI) will continue to operate businesses in nine states and accept new patients as it works with secured lender Quadrant Management to reorganize, the company announced Oct. 1. LMI hopes to emerge from Chapter 11 bankruptcy protection by the end of this year, according to the news release. It filed for bankruptcy in August, citing reduced revenue related to competitive bidding. Quadrant Management owns several HME suppliers in New Jersey, Pennsylvania...

INDIANAPOLIS - National Government Services (NGS), the DME MAC for Jurisdiction B, has reported a claims error rate for power wheelchair bases with options and accessories of 64% between April 1, 2013, and June 30, 2013. NGS examined 754 claims that were developed for additional documentation and it paid in full only 234 claims. The most common reason for denials: The physical and functional findings that were documented in the medical records failed to clearly establish medical necessity for power...