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Tag: Edits


OIG to CMS: Take stronger look at 'place-of-service' claims

July 2, 2018HME News Staff

WASHINGTON - CMS's edits didn't detect $18.4 million in payments in 2015 for inappropriate claims for DME provided during non-covered stays in skilled-nursing facilities, according to a report from the Office of Inspector General.This represents 6% of all payments for DME during non-covered stays in SNFs, the OIG says.CMS uses two edits that are designed to identify and reject such claims, but neither edit rejected the claims because SNFs and DME suppliers did not submit full and accurate information...

Edits, Office of Inspector General (OIG)

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In brief: PECOS edits kick in, Harrison speaks out

January 3, 2014HME News Staff

BALTIMORE - The PECOS edits are scheduled to go into effect today. Noridian Administrative Services, the DME MAC for Jurisdiction D, reminded providers in a Jan. 2 bulletin that Medicare planned to implement Phase 2 denial edits on Jan. 6. With the edits in effect, contractors will verify that the ordering/referring physician or healthcare provider on the claim is in the Physician Enrollment, Chain and Ownership System (PECOS), and is eligible to order/refer in Medicare. Ordering/referring physicians...

Doug Harrison, Edits, Investigation, PECOS, The Scooter Store

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