Tag: Andrea Stark

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...

WASHINGTON - CMS has rolled out a new settlement option for low-volume appeals, but it's not likely HME providers will take the agency up on its offer, stakeholders say.Providerswith fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals and the Medicare Appeals Council combined as of Nov. 3, 2017 with a total billed amount of $9,000 or less per appeal could be eligible, if certain other conditions are met.The kicker: CMS will settle eligible appeals at 62% of the net allowed...

MODESTO, Calif. - It's not every day that HME providers get good news from a CMS audit contractor, but Home Oxygen Company recently got a break from certain audits.The provider recently received word from Noridian, the Jurisdiction D MAC, that it had earned 12-month reprieves from widespread prepay reviews for both oxygen and CPAP.“It's a confidence builder,” said Andrea Ewert, CEO. “We are doing what they like, and we are going to keep it up.”Ewert plans to use the reprieve...

YARMOUTH, Maine - Sure, getting the money they're owed will be great, but are HME providers ready to process adjusted claims?“There are, surprisingly, a lot of internal process considerations,” said Andrea Stark, a reimbursement consultant for MiraVista. “These are going to be some of the more complex claims in your system.”N689, a recently announced remark code that will allow providers to identify adjustments will help, but other process considerations include how providers...