Tag: Noridian

WASHINGTON – Noridian Healthcare Solutions has posted FAQs for Jurisdictions A and D on the impact of the Philips recall on coverage and billing for Medicare beneficiaries, AAHomecare has reported.  Among the questions in the FAQ:  How should DME suppliers address the situation with Medicare beneficiaries who are in the first 90-days adherence metric in the PAP and RAD Local Coverage Determinations (LCDs)?  Response: During the Public Health...

FARGO, N.D. - Parenteral nutrition tops the list of error rates recently released by the Jurisdiction D DME MAC Noridian, AAHomecare reports. Codes B4185, B4193, B4197 and B4199 had a 100% error rate from TPE audits for the second quarter of 2019. Right behind parenteral nutrition was surgical dressings with an 86% error rate; hospital beds with a 72% error rate; and glucose monitors with a 65% error rate. AAHomecare did note that the error rates for enteral nutrition (20%) and manual wheelchairs...

FARGO, N.D. - Noridian Healthcare Solutions has taken over yet another CMS contract.The company, which is already the Medicare Administrative Contractor for jurisdictions A and D, and the Pricing Data Analysis and Coding contractor, among other things, has been awarded a $227 million contract to be the new Supplemental Medical Review Contractor.“Noridian has extensive DME experience in the field, so this is definitely in their wheelhouse,” said Andrea Stark, a reimbursement consultant...

FARGO, N.D. - Noridian Healthcare Solutions has been awarded a $227 million Supplemental Medical Review Contractor (SMRC) contract by CMS. The primary role of the SMRC is to conduct nationwide medical review of Part A, Part B and DME providers as directed by CMS. Its responsibility is to review medical records and related documentation to ensure that claims are processed in accordance with CMS guidelines. The SMRC contract was previously held by StrategicHealthSolutions. To support the new contract,...

WASHINGTON - CGS and Noridian have begun accepting prior authorization requests for K0856 and K0861, but complex rehab providers say they still don't have all the information they need to comply with the program.The contractors on March 6 began accepting requests for dates of delivery on or after March 20.“We're as prepared as we can be, with all the unanswered questions,” said Doug Westerdahl, president and CEO of Rochester, N.Y.-based Monroe Wheelchair, who, because of the uncertainty,...

Medtrade will have a dedicated area for showcasing point-of-purchase displays. “Ideas in Caretail: Point-of-Purchase and Small Spaces” will be offered in cooperation with The VGM Group and KC Fixtures. Medtrade will take place Oct. 26-29 at the Georgia World Congress Center in Atlanta�Noridian Healthcare Solutions has been re-awarded a contract for Jurisdiction D. It has administered the contract since 2006, processing claims for 17 states in the Midwest and West, plus American Samoa,...

FARGO, N.D. - A pre-payment review by Noridian found potential improper payment rates of 63% for CPAP devices from February to May 2014. The Jurisdiction D DME MAC reviewed 2,873 claims with the KH modifier (first month of billing) and 1,663 claims with the KJ modifier (4th-13th month of billing). It found most denials were due to invalid proof of delivery; no documentation in response to the additional documentation request letter; documentation submitted did not demonstrate that face-to-face...

WASHINGTON - All eyes in Washington, D.C., last week may have been on the Affordable Care Act and the website that couldn't, but that didn't stop stakeholders from meeting with legislative staffers to get a sense of what the industry might accomplish before the end of the year. “We are hearing that they will be doing a fix to take care of doctors before the holidays and that's the vehicle we've been looking for to include the market pricing program (MPP),” said Seth Johnson, vice president...

FARGO, N.D. - Noridian, the Jurisdiction D DME MAC is conducting prepayment reviews of oxygen and oxygen equipment claims, and compliance reviews of neb-med claims. For the period July 2013 through October 2013, Noridian found a potential improper payment rate of 65% on E0439 claims, and a potential improper payment rate of 69% on E0434 claims. In both cases, most denials were because physician signatures were dated after the date of service, or a verbal/dispensing order was not provided. Noridian...

FARGO, N.D. - Noridian Administrative Services has reported overpayments on some power mobility devices in Round 2 competitive bidding areas. Noridian says the problem stems from a system issue that led to DME MACs paying a higher rate than allowed under the program. Claims that meet the following criteria have been overpaid: processed on or after July 1, 2013, billed with the KJ modifier and submitted under a certain code (for a list of the codes, go here). Noridian says it will adjust these claims...