Tag: DME MAC

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...

FARGO, N.D. - Noridian Healthcare Solutions, the Jurisdiction D DME MAC, has published the results of prepayment reviews for a number of products. Oxygen (E1390) had a potential improper payment rate of 31% from March 2015 through May 2015. Group 2 pressure reducing support surfaces (E0277) had a potential improper payment rate of 62% from February 2015 though May 2015, while Group 1 pressure reducing support surfaces (E0181 and E0185) had improper rates of 52% and 63%, respectively, during that...

WASHINGTON - The DME MAC medical directors say they are fielding frequent complaints from doctors who are the targets of DME marketing schemes.The medical directors reminded physicians in a recent letter that they can report suspected abuse to the Office of Inspector General (OIG).“Most of these scams are obvious in their wording or their attempts to get you to approve unnecessary medical equipment and supplies,” the letter states.Common scams, according to the letter: unsolicited orders...

INDIANAPOLIS - National Government Services denied 79.8% of power wheelchair claims between Oct. 1 and Dec. 31 because paperwork failed to demonstrate beneficiaries' needs, according to a recent bulletin. The Jurisdiction B DME MAC reviewed 613 claims in a prepayment review of all group 2 power wheelchairs without the option of adding power seating. NGS found most were denied because face-to-face documentation failed to prove: a manual wheelchair was insufficient; that the beneficiary's mobility...

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 for...

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;...

INDIANAPOLIS - National Government Services (NGS), the DME MAC for Jurisdiction B, is experiencing delays updating the optical character recognition system it implemented to process CMS-1500 paper claims. Effective April 1, all paper claims must be submitted in that format; any files using the older format will be returned as unprocessable. Because of the delays, NGS is manually verifying paper claims data and has increased the inventory of paper claims awaiting validation, according to a recent...

WASHINGTON - Noridian Administrative Services, the DME MAC for Jurisdiction D, has changed its name to Noridian Healthcare Solutions, the organization announced in a message to its mailing list. The name change reflects some of Noridian's newer initiatives that branch out from its core business, including broader administrative services; program integrity offerings to mitigate fraud and abuse; and care and delivery management solutions designed to expand care and reduce patient care costs.

NASHVILLE, Tenn. - Celerian Group Company (CGS), a DME MAC healthcare claims processing company, has noticed an increase in the number of claims denied for having no Unique Tracking Number (UTN) as part of the PMD demo's prior authorization process, according to a bulletin. CGS's research suggests that providers are not putting the UTN in the correct location when submitting electronic claims. CMS is reminding suppliers to use either LOOP 2300 REFO2 or LOOP 2400 REFO2 for the UTN. In both instances,...

WASHINGTON - Ninety-five percent of claims for therapeutic shoes for persons with diabetes were denied in the third quarter of 2012, according to a prepayment review conducted by National Government Services, the DME MAC for Jurisdiction B. Of 258 claims reviewed, 246 were denied. Twenty-two percent were denied because requested documentation was not returned, while 63% were denied as not medically necessary. Some of the top issues contributing to the denials, according to the review, were lack of...