Tag: DME Medicare Administrative Contractor (DME MAC)

YARMOUTH, Maine – CGS has updated its FAQ on the Philips recall, adding two new questions and revising three questions. The two new questions are: If a beneficiary with a patient-owned recalled device refuses warranty support or chooses to purchase a replacement device out of pocket, will the DME MACs honor an executed ABN that holds the beneficiary responsible for replacement (outside of warranty) as same or similar to equipment previously purchased be Medicare? The DME MACs will...

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...

NASHVILLE - CGS Administrators, the Jurisdiction B DME MAC, has launched Mr. Wizard, an online tool that provides detailed information on claims under review and the status of additional documentation requests. Providers simply enter their 14-digit claim control number to receive information on type of denial received and detailed explanation; provider NPI; date of service, code billed, and links to education and resources for particular denials.

NASHVILLE - CGS Administrators will take over the Jurisdiction B DME MAC contract July 5. The myCGS portal registration window for suppliers will open three weeks prior, and the process is expected to be a simplified, express registration to ease the transition, the agency said during a recent call. Jurisdiction B suppliers will receive a written invitation to pre-register. Any unfinished claims processing, appeals and other work will be officially transitioned from the previous contractor, National...

YARMOUTH, Maine - Industry stakeholders are weighing the recent shake up in the DME MACs. For the first time ever, there will be two contractors handling claims processing for all four jurisdictions: CGS Administrators and Noridian Healthcare Solutions. “This is definitely a big change,” said Wayne van Halem, president of The van Halem Group. “The four jurisdictions have been around since 1993 and there have always been four unique companies doing it. (CGS and Noridian) have...

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...

FARGO, N.D. -A documentation compliance review for oxygen concentrators (E1390) from Sept. 1, 2014, to Nov. 30, 2014, resulted in an overall error rate of 21%, according to the Jurisdiction D DME MAC. The most common reasons for denial: proof of delivery (POD) was not submitted or was invalid; no documentation to support the beneficiary had been seen and evaluated by the treating physician within 30 days prior to the date of the initial Certificate of Medical Necessity (CMN); and no request documentation...

FARGO, N.D. - The Jurisdiction D DME MAC is conducting a documentation compliance review for nebulizer inhalation drugs (J7605 and J7626). The purpose is to verify whether submitted documentation meets payment requirements according to local coverage determinations. To avoid denial, providers should ensure requested documentation is sent to the contractor within the allotted timeframe, medical records supporting the management of obstructive pulmonary disease are submitted and refill requirements...

WASHINGTON - The DME MACs have issued a policy reminder to providers about CPAP therapy after a review of recent appeals identified denials associated with lack of compliance with requirements for continued coverage after the first three months of rental. At the end of the initial rental period, additional requirements must be met for rental and payments to continue: the treating physician must meet the beneficiary in person between the 31st and 91st days after initiating therapy for a re-evaluation...

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...