Tag: NGS

INDIANAPOLIS - National Government Services, the Jurisdiction B DME MAC, plans to target CPAP devices for a widespread prepayment medical review, it announced in a message yesterday. Providers randomly selected for review will receive an additional development request asking for a detailed written order for the CPAP device and any accessory billed on the same claim; medical records documenting a face-to-face clinical evaluation prior to the sleep test detailing symptoms of sleep disorder, their duration,...

INDIANAPOLIS - A prepayment review of glucose test strips resulted in a claim error rate of 99.2%, according to National Government Services. The Jurisdiction B DME MAC reviewed 8,758 claims filed between Jan. 1 and March 31. The top four reasons for denial: lack of medical necessity, documentation not returned within the requested time frame, billing more than the standard allowed quantity, and incorrect modifier submitted. Claims denied due to lack of medically necessary were: missing progress...

INDIANAPOLIS - The claim error rate for Group 2 power wheelchairs without power seating options was 87.7% between Jan. 1 and March 31, according to National Government Services (NGS), the Jurisdiction B DME MAC. Of 389 claims filed, 48 were paid in full, with the rest fully or partially denied. The most common reasons for denials: face-to-face documentation failed to prove a manual wheelchair wouldn't meet the beneficiary's needs in the home, the beneficiary had a significant mobility limitation...

INDIANAPOLIS - The claim error rate for Group 2 pressure reducing support surfaces (E0277) was 74% between July 1, 2013, and Sept. 31, 2013, according to a prepay review by National Government Services (NGS), the DME MAC for Jurisdiction B. NGS reviewed 275 claims: 239 were denied and 36 were approved. It found that 21% of claims were denied due to no response to the additional documentation request letter…The claim error rate for glucose test strips (A4253) was 98.5% between Oct. 1, 2013, and Dec....

NEW YORK - The Government Accountability Office (GAO) has denied Rotech's protest that the Department of Veterans Affairs (VA) unreasonably ignored recent, relevant information when it decided Rotech wasn't financially fit to win contracts to supply veterans with home oxygen equipment, Law360 reports. The VA contended that Rotech, which entered Chapter 11 bankruptcy protection in April, didn't qualify as a “responsible contractor,” according to the story. The VA's contracting officer...

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...

INDIANAPOLIS - Prior authorization requests submitted as part of the PMD demo are being denied because of conflicting information in face-to-face exams and other medical records, and insufficient face-to-face exam information, National Government Services (NGS) announced in a recent bulletin. The list of reasons covers denials as of Oct. 24. NGS says face-to-face exams often do not specify: how a PMD will sufficiently improve the beneficiary's daily life; what are the beneficiary's mobility limitations...