Tag: MiraVista

Q. How can suppliers find out when patients switch to Medicare Advantage Plans?  A. Because many patients forget to notify DME suppliers directly, denials from an inactive plan are often the first sign that a patient has changed insurance coverage. Fortunately, Medicare eligibility data is a powerful tool for identifying policy changes in advance. Search results include effective dates for plans that go into effect up to four months after the date of service queried.  A structured,...

Q. When can oxygen suppliers stop using the CMN?  A. Suppliers can stop using CMNs for oxygen setups with dates of service on and after Sept. 27, 2021. A recent change to the Home Use of Oxygen National Coverage Determination (NCD) eliminates the CMN requirement. In lieu of a CMN, suppliers need a standard written order from a treating practitioner.   To release initial claims for hypoxic patients, suppliers must confirm the medical records support the need for oxygen with test results...

Q. Can suppliers sell new CPAPs to Medicare beneficiaries who own a recalled machine but don’t want to wait for warranty repairs?  A. Yes. When the equipment is over five years, it has exceeded its reasonable useful life. Suppliers can bill new equipment to Medicare with a new prescription.  If the patient’s equipment is less than five years old, Medicare will not pay for a new machine because the equipment remains within the useful lifetime.  Patients may want...

WASHINGTON – CMS has announced that a systems-wide error resulted in suppressed crossover claims to certain supplemental payers from April 8 through early May, MiraVista reports. The issue affects Medicare claims finalized between April 8 and April 25 for electronic claims, and between April 8 and May 11 for paper claims. Medicare did not send crossover claims to the following payers, according to MiraVista: Anthem BCBS (Connecticut, New Hampshire, Maine and Vermont); BCBS (Michigan and Maine);...

COLUMBIA, S.C. – The Provider Relief Fund Reporting Portal is open, but right now, providers can only register on the website, according to MiraVista. The Department of Health and Human Services hasn’t specified when reporting features will be available, but providers that received more than $10,000 from the PRF should register now to receive email notifications and updates, the consulting firm says. Because the portal times out after 15 minutes of inactivity, MiraVista recommends...

MODESTO, Calif. - It's not every day that HME providers get good news from a CMS audit contractor, but Home Oxygen Company recently got a break from certain audits.The provider recently received word from Noridian, the Jurisdiction D MAC, that it had earned 12-month reprieves from widespread prepay reviews for both oxygen and CPAP.“It's a confidence builder,” said Andrea Ewert, CEO. “We are doing what they like, and we are going to keep it up.”Ewert plans to use the reprieve...

Since it's been so long since HME providers have had to grapple with a RAC, stakeholders offered these pieces of advice:Be proactive. “Suppliers must have an internal quality assurance and compliance program that regularly monitors the claims that are being submitted,” said Wayne van Halem, president of The van Halem Group, a division of The VGM Group. “They should review the RAC website regularly to perform a risk assessment on their proactive audits. Suppliers can minimize the...

YARMOUTH, Maine - Recent revisions to the documentation requirements for CPAP resupplies are a “huge win,” but industry stakeholders want further clarification.CMS will now assume that medical necessity has been established for replacement of accessories for beneficiary-owned CPAP and RAD devices.Still, stakeholders would like to see the agency clarify—in writing—what documentation HME providers still need to get paid for accessories.“You need a detailed written order...

WASHINGTON - Recent guidance from the DME MACs on coverage criteria for ventilators is a move in the right direction, say industry stakeholders.Specifically, the guidance removes the so-called “imminent death requirement,” which stated that patients must need a ventilator 24/7 for coverage.It's a requirement the MACs issued in April 2015 in an attempt to define criteria for vents vs. bi-level devices.The new guidance doesn't go that far, but “makes very clear that any device which...

MiraVista, a consulting and outsourced billing company for DME providers, has redesigned its website to make its industry updates, and education events and tools front and center. The new site is also mobile friendly…PMDRX recently demoed its mobility exam and documentation technology to the office of U.S. Rep. Trent Franks, R-Ariz. With help from Franks' office, PMDRX has completed an application for a $250,000 Arizona Innovation Challenge grant that would allow it to launch an aggressive marketing...