Tag: reviews

LIVERMORE, Calif. - Performant Recovery, the new national recovery audit contractor for DMEPOS and home health/hospice, announced March 8 that it has officially received approval from CMS to begin audit activity. The RAC in February posted seven new reviews on its workload page: complex medical necessity chest wall oscillation devices; complex medical necessity tracheotomy suction catheters, suction pumps, catheters and other related supplies and equipment; automated nebulizers not in accordance...

WASHINGTON - SMRC contractors will give providers more time to respond to results letters, AAHomecare reported this week. The association had notified CMS that providers were being inundated with letters, and reviewing them and gathering supporting documents has been an overwhelming process. If providers need more time, they can send a written request to the SMRC for a discussion and education session within 30 days of the date of the final results letter, AAHomecare says. In their requests, providers...

FARGO, N.D. - Noridian Healthcare Solutions, the Jurisdiction D DME MAC, has published the results of prepayment reviews for a number of products. Oxygen (E1390) had a potential improper payment rate of 31% from March 2015 through May 2015. Group 2 pressure reducing support surfaces (E0277) had a potential improper payment rate of 62% from February 2015 though May 2015, while Group 1 pressure reducing support surfaces (E0181 and E0185) had improper rates of 52% and 63%, respectively, during that...

INDIANAPOLIS - So far, few providers in Jurisdiction B seem to be affected by a recent prepayment review for manual wheelchair bases, including adult tilt-in-space models (E1161).“We don't have a lot of people billing E1161 in Region B since they changed it to a rental, so I don't think we're doing as many as we used to,” said billing consultant Sylvia Toscano, owner of Professional Medical Administrators. “It's possible, but I haven't seen it yet.”The probe, launched...

WASHINGTON - CMS began requiring fingerprint-based background checks for certain providers on Aug. 6, according to an MLN Matters article. The checks will first impact individuals with a 5% or greater ownership interest in a provider that falls into the high-risk category and is currently enrolled in Medicare or has submitted an initial enrollment application. The checks will be implemented in phases—not all providers in the high-risk category will be part of the first phase. Providers will...

WASHINGTON - CMS announced last week that the recovery audit contractors (RACs) will restart some of their reviews, but industry stakeholders don't expect any curveballs.Due to delays in awarding new contracts, the agency is giving the RACs the green light to get back to work on automated reviews and, on a limited basis, complex reviews.“It doesn't sound like they're authorizing new audits, just reactivating the audits that they previously allowed,” said Andrea Stark, a reimbursement...

WASHINGTON - CMS has announced that the current recovery audit contractors (RACs) will restart some of their reviews.The RACs have been on hiatus from sending post-payment additional documentation requests (ADRs) since February, as part of the agency's transition to new RACs.But, apparently, that transition is taking longer than CMS anticipated.“Due to the continued delay in awarding new recovery auditor contracts, CMS is initiating contract modifications to the current recovery auditor contracts...

Although error rates remain high for standard power wheelchair claims, a CMS contractor announced on Dec. 29 that it plans to discontinue its review due to upcoming changes in payment for K0823. In the second quarter, from September 2010 through November 2010, Noridian Administrative Services (NAS), the Jurisdiction D DME MAC, found that of 253 claims reviewed, 232 were denied, resulting in an error rate of a whopping 92%. On Jan. 1, however, Medicare eliminated the first-month purchase option for...