Tag: National Government Services

INDIANAPOLIS - In a first quarter 2014 widespread payment review of vacuum erection devices (VEDs), National Government Services examined 67 claims and denied 47, for an error rate of 70%, according to a release. The most common reasons for denial were: documentation that did not support diagnosis of impotence or erectile dysfunction; no medical records submitted; no documentation to support diagnosis of impotence or erectile dysfunction to allow coverage for the device; the proof of delivery record...

INDIANAPOLIS - National Government Services denied 79.8% of power wheelchair claims between Oct. 1 and Dec. 31 because paperwork failed to demonstrate beneficiaries' needs, according to a recent bulletin. The Jurisdiction B DME MAC reviewed 613 claims in a prepayment review of all group 2 power wheelchairs without the option of adding power seating. NGS found most were denied because face-to-face documentation failed to prove: a manual wheelchair was insufficient; that the beneficiary's mobility...

INDIANAPOLIS - National Government Services (NGS), the DME MAC for Jurisdiction B, is experiencing delays updating the optical character recognition system it implemented to process CMS-1500 paper claims. Effective April 1, all paper claims must be submitted in that format; any files using the older format will be returned as unprocessable. Because of the delays, NGS is manually verifying paper claims data and has increased the inventory of paper claims awaiting validation, according to a recent...

INDIANAPOLIS - Prior authorization requests submitted as part of the PMD demo are being denied because of conflicting information in face-to-face examinations and other medical records, and insufficient face-to-face examination information, National Government Services announced in a recent bulletin. The list of reasons covers denials as of Oct. 24. NGS says face-to-face exams often do not specify: how a PMD will sufficiently improve the beneficiary's daily life; the patient's mobility limitations,...

INDIANAPOLIS - National Government Services, the Jurisdiction B DME MAC, plans to conduct a widespread prepayment review of nebulizers, related drugs, accessories and dispensing fees, it announced Oct. 29. The review is an expansion of a documentation review now being conducted on oxygen equipment and glucose supplies. Suppliers of selected claims will receive a request in the mail asking for copies of the signed and dated detailed written order, applicable dispensing orders, records supporting medical...

WASHINGTON - The Office of Medicare Hearings and Appeals (OMHA) will defer assignments for hearings—possibly up to 28 months, according to a recent notice. Requests for hearings received after July 15, 2013, will be entered into the agency's case processing system and held until there is room on an Administrative Law Judge's (ALJ) docket for adjudication. When a request is assigned, a notice will be sent, according to the notice. The ALJs have been backlogged for more than a year,...

BALTIMORE - National Government Services, the Jurisdiction B DME MAC, is conducting a widespread prepay review of power wheelchairs without power seating options. The DME MAC processed 636 claims between July 1, 2013 and Sept. 1, 2013, and said 572 claims needed more documentation, according to a recent bulletin. Partial and full denials of those claims resulted in a 77% error rate. Denials were most common when documentation did not prove a manual wheelchair was unsuitable, did not demonstrate why...

WASHINGTON - National Government Services, the DME MAC for Jurisdiction B, has developed a new website for providers submitting prior authorization requests as part of the PMD demo in seven states. The new site contains an overview of the PMD demonstration, educational resources and documentation templates.

WASHINGTON - A prepayment review of power wheelchair claims processed in Jurisdiction B resulted in an 80% error rate, according to National Government Services (NSG), the DME MAC there. Of 1,022 claims processed from Oct. 1 2012�-Dec. 31, 2012, 122 were paid in full, while the remaining claims were completely or partially denied, according to the review. The most common reasons for denials were: Local Coverage Determination (LCD) criteria not met; face-to-face examination with a physician not established;...

WASHINGTON - A prepayment review of intermittent catheterization kits processed in Jurisdiction B resulted in an 85.6% error rate, according to National Government Services (NGS), the DME MAC there. Of 257 claims processed from Sept. 1-Dec. 31, 2012, 220 were denied, according to the review. The most frequent denial—“failure to meet one or more of the required coverage criteria”—accounted for 37% of denied claims. Sixty-one of the claims were denied because the requested documentation...