Tag: Andrea 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...

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...

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...

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...

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...

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...

In the recent ESRD Proposed Rule, CMS conveyed their intent to freeze reimbursement in Competitive Bid Areas (CBAs) using the single payment amounts (SPAs) when the program ends on Dec. 31/2018.* CBAs encompass the most populous areas of the country and have the greatest impact on Medicare spend dollars.** In recent conversations with industry legal experts, MiraVista put forth three central questions: Does CMS have the authority to freeze SPAs without contracts? If not SPAs, then what is the reimbursement...

WASHINGTON - Christmas has come early for HME providers who have disputed Medicare claims.CMS announced last week that it plans to expand a demonstration project—one that allows providers to speak with reconsideration professionals by phone to try to resolve their denied claims; or re-open denied claims that are stuck at the administrative law judge level—to jurisdictions A and B on Nov. 1.“We've been waiting for this with bated breath,” said Andrea Stark, a reimbursement...

YARMOUTH, Maine - The Medicare landscape could look very different on Jan. 1, 2019, but industry watchers don't expect any knee-jerk reactions from HME providers.In a recent proposed rule, CMS outlined its plans to implement an “any willing provider” provision when the current competitive bidding contracts expire on Dec. 31, allowing any Medicare-enrolled provider to serve beneficiaries while it overhauls the program.“The guns will go off on Jan. 1, but I don't expect anyone to...

WASHINGTON - CMS has changed the guidelines for reporting a patient's oxygen flow rate on a CMN, a move that will have two serious implications for providers, particularly those servicing the critically ill, says Andrea Stark.First, through new modifiers laid out in a Feb. 15 joint DME MAC publication, CMS has instructed that for patients whose oxygen use differs between day and night, the average flow rate, not the highest flow rate, must be reported on question 5 of the CMN.“They say this...