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Tag: Andrea Stark


Andrea Stark

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‘There needs to be a way to recognize a patient as being part of PHE’

May 13, 2022Liz Beaulieu, Editor

WASHINGTON – Industry stakeholders are trying to guide what a post-PHE world for home oxygen therapy and other product categories might look like.  AAHomecare recently discussed with CMS a one-page recommended reference document for Medicare audit contractors reviewing claims for dates of service during and after the PHE. The document is a cheat sheet of sorts for the waivers that have been in place during the PHE that don’t require, for example, medical documentation or a signature.  “It...

Andrea Stark, Home oxygen therapy, Kim Brummett, PHE


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Andrea Stark

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Stark on oxygen NCD’s ripple effects, gaps

January 7, 2022Liz Beaulieu, Editor

YARMOUTH, Maine – Andrea Stark says the HME industry hasn’t experienced a coverage expansion like what’s in the new NCD for home oxygen therapy in recent history.  Stark, the head of reimbursement at MiraVista LLC, was a guest on a recent HME News in 10 podcast to talk about the ripple effects of the new NCD, which expands coverage to acute conditions and eliminates the CMN requirement, and how the DME MACs will interpret the new policy.  Caught by surprise  “CMS...

Andrea Stark, Home Oxygen, Oxygen NCD


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Andrea Stark

Smart Talk

Regulatory: Reduce denials, service gaps 

December 8, 2021Andrea Stark

Q. How can suppliers find out when patients switch to Medicare Advantage Plans?  A. Because many patients forget to notify DME suppliers directly, denials from an inactive plan are often the first sign that a patient has changed insurance coverage. Fortunately, Medicare eligibility data is a powerful tool for identifying policy changes in advance. Search results include effective dates for plans that go into effect up to four months after the date of service queried.  A structured,...

Andrea Stark, Medicare Advantage, MiraVista


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Andrea Stark

Smart Talk

Regulatory: Watch out for MAC instructions

November 10, 2021Andrea Stark

Q. When can oxygen suppliers stop using the CMN?  A. Suppliers can stop using CMNs for oxygen setups with dates of service on and after Sept. 27, 2021. A recent change to the Home Use of Oxygen National Coverage Determination (NCD) eliminates the CMN requirement. In lieu of a CMN, suppliers need a standard written order from a treating practitioner.   To release initial claims for hypoxic patients, suppliers must confirm the medical records support the need for oxygen with test results...

Andrea Stark, MiraVista, Oxygen CMN


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Stark

Smart Talk

Regulatory: Verify, verify, verify

October 13, 2021Andrea Stark

Q. Can suppliers bill monthly rentals for Medicare patients with recalled Philips CPAP devices? A. Yes, so long as the patient continues to use the device. Suppliers, however, should be increasingly diligent in their monthly verification procedures because the publicity surrounding the recall may persuade regular CPAP users to stop using their machines, even those produced by Philips’ competitors. Remote monitoring is the easiest way to satisfy the requirement, but suppliers can also...

Andrea Stark, CPAP, Home Medical Equipment, Philips Recall


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ST Stark

Smart Talk

Regulatory: Use non-technical words 

September 13, 2021Andrea Stark

Q. Can suppliers sell new CPAPs to Medicare beneficiaries who own a recalled machine but don’t want to wait for warranty repairs?  A. Yes. When the equipment is over five years, it has exceeded its reasonable useful life. Suppliers can bill new equipment to Medicare with a new prescription.  If the patient’s equipment is less than five years old, Medicare will not pay for a new machine because the equipment remains within the useful lifetime.  Patients may want...

Andrea Stark, Home Medical Equipment, MiraVista


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Andrea Stark

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Andrea Stark makes case for making demo permanent

September 10, 2021Liz Beaulieu, Editor

YARMOUTH, Maine – The contract may be running out for a demonstration that allows HME providers to try to resolve denied claims by phone, but Andrea Stark says, “We’re onto something here,” and hopes CMS will make it a permanent part of the statement of work for the QIC.  The QIC, which is run by Maximus, recently announced it is winding down the demo per a contract that ends Dec. 31, 2021.  “Clearly, DME is complicated and suppliers feel better when...

Andrea Stark, Appeals, Home Medical Equipment, QIC


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Depending on the contractor, audits are very much up and running

September 4, 2020Liz Beaulieu, Editor

COLUMBIA, S.C. - Audits have started to pop up in a number of places, including more recently, from the SMRC, says Andrea Stark. “I haven't seen any posts to the SMRC website announcing new audits, but I'm starting to hear the initial murmurings from suppliers they are receiving audit requests from the SMRC that may involve vents or oxygen - indicating a respiratory related review,” said Stark, a reimbursement consultant with MiraVista. “But they're non-public audit requests so...

Andrea Stark, Audits, SMRC


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Audit round up: RACs cut checks, UPICs run roughshod

June 28, 2019Theresa Flaherty, Managing Editor

YARMOUTH, Maine - Nearly two years after Performant Recovery announced it would perform an underpayment review for Group 3 power wheelchair options, providers are receiving refund checks, says Andrea Stark.Performant, the DMEPOS RAC, announced in May 2017 it would review wheelchair accessories, including seating systems, and seat and back cushions furnished in conjunction with codes K0848—K0864 for the six-month period of Jan. 1, 2016—June 30, 2016. The review was necessary because CMS...

Andrea Stark, Elizabeth Hogue, Kelly Grahovac, Performant Recovery, RAC, UPIC


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CMS makes concessions for support surfaces

June 7, 2019Theresa Flaherty, Managing Editor

WASHINGTON - CMS has implemented a shorter, five-day turnaround time for prior authorizations for support surfaces, but there are no changes to the coverage criteria, CMS officials said during a Special Open Door Forum on June 4.The agency will turn around expedited PA requests for support surfaces in two days, it says.“We realize that the support surfaces process is a lot different than with power mobility,” a CMS official said during the call. CMS announced in April that it planned...

Andrea Stark, Prior auths, support surfaces


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