CGS announces reviews for back braces, test strips

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Thursday, August 13, 2020

ATLANTA – CGS has announced that the Jurisdiction B medical review department will begin complex post-pay service-specific reviews on back braces and test strips, according to the van Halem Group. 

Both reviews are the result of data analysis that indicates the allowed dollars for the two codes in Jurisdiction B are significantly above expected amounts. Each code also ranks high in the CERT Errors Top 15, with L0650 ranking No. 6 and A4253 No. 11, according to the van Halem Group. 

Based on earlier information from CMS, which restarts audit activity this month, post-payment reviews will be on items/services provided before March 1, 2020. 

van Halem Group highlighted the following from CGS’s announcement: “CGS would like to remind suppliers of the importance of responding to additional documentation request letters. Suppliers are in violation of Supplier Standard #28 when, upon request, they fail to provide requested documentation to a Medicare contractor. Therefore, the consequences of failure to provide records may not only be a claim denial but also referral to the National Supplier Clearinghouse.” 

A referral to the NSC, the van Halem Group points out, will likely result in unannounced site inspection visits or even investigations by a provider’s Supplier Audit and Compliance Unit. Violations of DMEPOS supplier standards can result in revocation of a supplier number for a minimum of a year.