Skip to Content

Tag: Audits


News

Legal spotlight: Mandates, audits

April 2, 2022Liz Beaulieu, Editor

AMARILLO, Texas – With the roller coaster of vaccine mandates and the uptick in audits, legal issues are keeping HME providers on their toes, say Jeff Baird and Denise Leard. Baird and Leard, both health care attorneys with Brown & Fortunato, gave HME News a look into the latest developments on these two topics.  Vaccine variables The long story short, Baird says, is if you’re an HME company, you have to worry about whether or not your employees are visiting a health care facility...

Audits, Denise Leard, Home Medical Equipment, Jeff Baird, vaccines


Read Full Articlered right arrow icon

ALJ backlog: Providers will have ‘fighting chance’ again

News

ALJ backlog: Providers will have ‘fighting chance’ again

February 18, 2022Liz Beaulieu, Editor

ATLANTA – The Office of Medicare Hearings and Appeals should be caught up on a years-long backlog of appeals at the administrative law judge (ALJ) level sometime this summer, predicts Wayne van Halem, president of the van Halem Group.   That means OMHA should be back to holding hearings at the ALJ level within 90 days as required by law, he says.  “The appeals process has to be timely,” he said. “If the appeals process is timely and Medicare has to hold off...

ALJ, Audits, Home Medical Equipment, van Halem Group, Wayne van Halem


Read Full Articlered right arrow icon

Also Noted

SMRC audits orthopedic footwear

January 18, 2022HME News Staff

WASHINGTON – Noridian Healthcare Solutions, the Supplemental Medical Review Contractor for CMS, is conducting post-payment reviews for orthopedic footwear claims from Jan. 1, 2019, through Dec. 31, 2019. Orthopedic footwear is covered under the “leg, arm, back and neck braces, and artificial legs, arms and eyes” benefit. Coverage is provided when coverage, coding and documentation requirements are met. The reviews will include base and accessory codes. Noridian noted that this service...

Audits, Orthopedic footwear, SMRC


Read Full Articlered right arrow icon

Kelly Grahovac

News

Audits slowly ramp up

July 9, 2021Theresa Flaherty, Managing Editor

WASHINGTON – The DME MACs are moving forward with audits for claims filed after March 2020, when COVID-19 hit the U.S. and certain waivers went into effect, but audit experts don’t anticipate any widespread problems.  Early in the pandemic, CMS temporarily waived several requirements, including coverage criteria, face-to-face requirements and delivery signatures for respiratory equipment.   “The MACs have been easing into audits since last August, even though...

Audits, COVID-19, Respiratory Therapy, waivers


Read Full Articlered right arrow icon

Also Noted

CGS launches review of No. 1 product category for CERT errors

March 22, 2021HME News Staff

NASHVILLE, Tenn. – CGS will be conducting complex post-pay, service-specific medical review of lower limb prostheses, L5700 and L5701, the contractor announced on March 19. “This review will be conducted because data analysis revealed that Jurisdiction C’s allowed dollars for L5700 and L5701 were significantly above expected amounts,” CGS stated. “Additionally, the orthotics policy group ranked No. 1 in total comprehensive error rate testing (CERT) errors.”...

Audits, CGS, Medical review, Prostheses


Read Full Articlered right arrow icon

News

CGS adds ostomy supplies, diabetic shoes to reviews

September 23, 2020HME News Staff

NASHVILLE, Tenn. - CGS has announced two more widespread post-pay, service-specific reviews for ostomy supplies and therapeutic shoes/inserts. For ostomy supplies, the codes affected are A4431, A4434, A5081, A5122. CGS says data analysis showed Jurisdiction C's allowed dollars for these codes were significantly above expected amounts. Additionally, these codes were consistently ranked in the top 20 for CERT errors. For therapeutic shoes/inserts, the codes affected are A5500 and A5512 through A5514....

Audits, CGS, Diabetic Shoes, Ostomy


Read Full Articlered right arrow icon

News

In brief: Audits pile up, M&A heats up, Masimo sues Apple

September 18, 2020HME News Staff

WASHINGTON - CGS, the DME MAC for jurisdictions B and C, will be conducting complex post-pay reviews for surgical dressings and knee orthoses, according to AAHomecare. CGS will be reviewing A6196 and A6212, and L1833 and L1851. The DME MAC is conducting the reviews due to data analysis that showed “significantly above expected amounts.” Surgical dressings and knee orthoses also ranked No. 5 and No. 9, respectively, in total CERT improper payment rates. The reviews will include only claim...

Audits, Lawsuit, M&A


Read Full Articlered right arrow icon

News

Audits start to pile up

September 15, 2020HME News Staff

WASHINGTON - CGS, the DME MAC for jurisdictions B and C, will be conducting complex post-pay reviews for surgical dressings and knee orthoses, according to AAHomecare.CGS will be reviewing A6196 and A6212, and L1833 and L1851. The DME MAC is conducting the reviews due to data analysis that showed “significantly above expected amounts.”Surgical dressings and knee orthoses also ranked No. 5 and No. 9, respectively, in total CERT improper payment rates. The reviews will include only claim...

Audits, CGMs, DME MAC, Dressings, Orthotics, RAC, urological supplies


Read Full Articlered right arrow icon

News

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


Read Full Articlered right arrow icon

News

RAC notifies providers of reviews

August 21, 2020HME News Staff

WASHINGTON - Performant, Medicare's RAC, has notified providers by letter that, per authorization from CMS, it will resume certain medical review activities, according to the van Halem Group.The notification says providers have an additional 30 days to submit discussion requests for review for result and initial findings letters dated Feb. 27, 2020, to March 27, 2020. It also advises providers to access the Provider Portal to review any claims pertaining to those dates.Performant most recently posted...

Audits, Beds, Manual Wheelchairs, RAC


Read Full Articlered right arrow icon