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Tag: CGS

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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

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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

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Regulatory: Peformant, CGS

May 23, 2019HME News Staff

WASHINGTON - Reformant Recovery, the National DMEPOS RAC Contractor, has added upper limb orthoses to its approved issues list. Performant will review claims for upper limb orthoses with dates of service within five years of the date of service of a previously paid upper limb orthoses for the same beneficiary. HCPCS codes identified as same, for the same anatomical site, will be denied as the reasonable useful lifetime requirement has not been met The Jurisdiction B and C councils met recently to...

CGS, RAC, Reformant Recovery

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It's a bumpy start for prior authorizations

March 10, 2017Liz Beaulieu, Editor

WASHINGTON - CGS and Noridian have begun accepting prior authorization requests for K0856 and K0861, but complex rehab providers say they still don't have all the information they need to comply with the program.The contractors on March 6 began accepting requests for dates of delivery on or after March 20.“We're as prepared as we can be, with all the unanswered questions,” said Doug Westerdahl, president and CEO of Rochester, N.Y.-based Monroe Wheelchair, who, because of the uncertainty,...

CGS, Complex Rehab, K0856, K0861, Noridian, Prior authorization

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CGS launches manual wheelchair review

February 20, 2014HME News Staff

NASHVILLE, Tenn. - High strength, lightweight manual wheelchairs will be the subject of a service-specific prepayment review because of their high claims payment error rate, CGS, the Jurisdiction C DME MAC, announced Feb. 18. Additional documentation required for K0004 claims may include: detailed written orders; medical records showing the beneficiary meets general manual wheelchair coverage criteria and one of the two K0004 code specific criteria; documentation of an assessment showing the beneficiary's...

CGS, Manual wheelchair, Prepayment review

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Cushions up for prepayment audit

January 15, 2014HME News Staff

NASHVILLE, Tenn. - CGS, the DME MAC for Jurisdiction C, will implement a prepayment edit for E2603 (skin protection wheelchair seat cushion, any depth, but less than 22 inches wide) and E2622 (adjustable skin protection wheelchair seat cushion, any depth, less than 22 inches wide). The contractor is conducting the edit because of high claims payment error rates for this product category, according to a Jan. 14 bulletin. For claims subjected to the edit, providers will need to provide delivery documentation;...

CGS, DME MAC, Prepayment audit, wheelchair seat cushions

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CGS posts warning for enteral claims

September 23, 2013HME News Staff

NASHVILLE, Tenn. - An increasing number of errors in Medicare claims for enteral nutrition have led claims processor CGS to post a reminder on its website about documentation and billing requirements. The post details the necessary information that must be included in DME equipment information forms, detailed written orders and clinical records to demonstrate the type of nutrient needed and the continuing medical need for enteral nutrition.

CGS, DME, Enteral Nutrition

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Oxygen LCD gets updated

September 14, 2012HME News Staff

NASHVILLE, Tenn. - CGS, the DME MAC for Jurisdiction C, posted changes to the local coverage determination (LCD) for oxygen on Sept. 13. Two big changes: exercise testing must be supervised by a physician or other qualified individual; and home sleep testing requirements are limited to standalone overnight pulse oximetry. The revised LCD goes into effect Oct. 1, 2012.