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Tag: Claims


Also Noted

Trella Health ramps up claims dataset 

September 25, 2023HME News Staff

ATLANTA – Trella Health, a provider of market intelligence and integrated customer relationship management (CRM) solutions, is expanding its dataset to provide its home medical equipment and infusion customers with deeper visibility into their markets through advanced metrics and analytics. “We’re acting on what our customers have been telling us,” said Pierre Menard, chief technology officer at Trella Health. “While Trella provides a unique and valuable view into HME...

Claims, Customer Relationship Management (CRM), Data, market intelligence, Trella Health


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Also Noted

CareCentrix addresses concerns during meeting

September 25, 2019HME News Staff

WASHINGTON - CareCentrix has begun a system-wide analysis to determine areas where it can improve its processes, and started working with insurance plans to improve the reconsideration process and timeliness of responses, AAHomecare reports. The developments were the result of a recent meeting between association and CareCentrix officials. “Suppliers and major payer groups have a shared responsibility to support patients, caregivers and clinicians with quality HME products and services,”...

CareCentrix, Claims


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News

Regulatory news: CMS revamps audits, lawmakers question CPAP bundling

August 18, 2017HME News Staff

WASHINGTON - Claims submitted by providers that have the highest claim error rates or billing practices that vary significantly from their peers will soon face increased scrutiny, CMS has announced. As part of an expanding “Targeted Probe and Educate” program, the Medicare Administrative Contractors will identify these providers through data analysis. “TPE claim selection is different from that of previous probe and educate programs,” the agency stated in an Aug. 14...

Bundled Payments, Claims, Competitive Bidding, CPAP, Review


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News

CMS revamps claims review process

August 16, 2017HME News Staff

WASHINGTON - Claims submitted by providers that have the highest claim error rates or billing practices that vary significantly from their peers will soon face increased scrutiny, CMS has announced. As part of an expanding “Targeted Probe and Educate” program, the Medicare Administrative Contractors will identify these providers through data analysis. “TPE claim selection is different from that of previous probe and educate programs,” the agency stated in an Aug. 14...

Claims, Data Analysis, Review


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Providers

QIC demo sets 'different tone'

May 13, 2016Tracy Orzel

Kansas City, Mo. - Able Care Health Equipment in Kansas City, Mo., was recently selected to take part in a new demo project that provides a more interactive process for resolving claims at Medicare's second level of appeals. The demo, launched in January by C2C Innovative Solutions, Medicare's Qualified Independent Contractor or QIC, allows providers to speak with a reconsideration professional by phone to try and resolve their cases. Jason Hood, CFO of Able Care Health Equipment, spoke...

Claims, Medicare


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Also Noted

CMS repairs web glitch

January 27, 2014HME News Staff

NASHVILLE, Tenn. - CMS has corrected an issue in the DME MAC claim system that had been affecting processing, CGS said in a Jan. 24 bulletin. Claims are now being processed using ordering/referring physician data from PECOS, according to the statement. Any claims incorrectly denied because of the problem will be reprocessed automatically, CGS said. In addition, the myCGS web portal and Jurisdiction C IVR are assessing the corrected ordering/referring physician file, according to the bulletin.

Claims, CMS, DME Medicare Administrative Contractor (DME MAC)


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News

In brief: CMS reports glitch, OIG reports overpayments

January 17, 2014HME News Staff

NASHVILLE, Tenn. - A problem with ordering/referring physician data in the DME MAC claim system is affecting processing, as well as the data available in the myCGS web portal and the Jurisdiction C IVR, according to a bulletin from CGS. CMS and DME MAC system maintenance contractors are researching the issue. CGS says it will provide more information when it becomes available. CMS on Jan. 6 started denying claims with the names of physicians who are not enrolled in PECOS. Medicare overpays...

American Association of Diabetes Educators (AADE), Audit, BioScrip, CareFusion, Claims, Community Pharmacy, Comparative Billing, Convaid, CPAP, Diabetes Testing Supplies, DME Medicare Administrative Contractor (DME MAC), Documentation, FAA, Medicare, Molnylcke, National Government Services (NGS), Office of Inspector General (OIG), Orthofeet, Ottobock, Payment, Sleep Apnea, spinal cord injuries, Telehealth, vacuum erection systems, VGM Group, Wheel:Life, Wheelchair


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CMS reports PECOS-related glitch

January 16, 2014HME News Staff

NASHVILLE, Tenn. - A problem with ordering/referring physician data in the DME MAC claim system is affecting processing, as well as the data available in the myCGS web portal and the Jurisdiction C IVR, according to a bulletin from CGS. CMS and DME MAC system maintenance contractors are researching the issue. CGS says it will provide more information when it becomes available. CMS on Jan. 6 started denying claims with the names of physicians who are not enrolled in PECOS.

Claims, CMS, DME Medicare Administrative Contractor (DME MAC), PECOS


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Specialty Providers

Providers targeted for certain claims

July 22, 2010Theresa Flaherty, Managing Editor

ALEXANDRIA, Va. - Medicare is demanding repayment for diabetes and other Part B supplies that it says should have been billed to other payers, but industry stakeholders say the products were dispensed in "good faith." "We are worried this is just getting started and it's going to get bigger," said Susan Janeczko, director of long term, regulatory and policy affairs, for the National Community Pharmacists Association (NCPA). "They are going back to 2006, then they could work their way up." The issue:...

Claims, Diabetes, Repayment


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