Tag: Medicare audits

WASHINGTON – The Qualified Independent Contractor (QIC) will begin winding down the demonstration that ends Dec. 31, 2021.   The demonstration project allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases. Providers are being asked not to delay in returning participation forms or documentation.  The Medicare Councils will be convening a workgroup to put together communications to CMS on the concerns over the demonstration ending...

WASHINGTON - The average wait time to get a hearing before an Administrative Law Judge is 1,082 days, a 41-day increase from earlier this year and a 205-day increase since last year, according to AAHomecare. The overturn rate at the ALJ is 28.3%. The Office of Medicare Hearings and Appeals recently said it will no longer publish detailed workload information showing the breakdown of the number and type of appeals at the ALJ; however, it has offered to share DMEPOS-specific data with AAHomecare.

WASHINGTON - CMS has announced significant improvements to the processing of serial claims for capped rental items and certain inexpensive and non-routinely purchased items, according to a bulletin from AAHomecare.It's an issue that has been a challenge for providers for years and contributed to the massive appeals backlog, the association says.Improvements include:Instructing the DME MACs to change the process by which they adjudicate appeals of serial claims. Once the reason for denial for one...

Mr. Watson's letter (“28-month delay will be disasterous for providers,” January 2014) was right on the money, no pun intended. It will be disastrous for providers, but the real loser here is the person who must live his or her life from the seat of a wheelchair. We have a number of clients who have rather complicated power wheelchairs. A number of the chairs were initially paid for, but Medicare has been retrieving money on those paid claims at...

If you remember The Roy Rogers Show, you might remember Roy's sidekick, Pat, driving the old Jeep nicknamed Nellie Belle. On occasion, Nellie Belle would get out of control and Pat would yell, “Whoa Nellie Belle.”Today, we have a different vehicle out of control: Medicare. Someone needs to holler “Whoa Nellie!” and put a stop to this runaway, out-of-control renegade before someone gets hurt.HME providers, hospitals, physicians, and home health and hospice agencies...