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Tag: prepayment review


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DME MAC releases oxygen, CPAP review data

May 29, 2014HME News Staff

HINGHAM, Mass. - NHIC found a 44% denial rate for oxygen and oxygen equipment as part of a review of claims filed between Jan. 1, 2014, and March 31, 2014. The Jurisdiction A DME MAC reports responses to additional documentation requests were not received for 59% of the claims. For the same time period, the NHIC found a 64.3% denial rate for CPAP devices. Oxygen claims were most frequently denied for missing documentation; failing to meet written order prior to delivery requirements; and failing...

CPAP, NHIC, Oxygen, oxygen equipment, prepayment review


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Prepayment review focuses on CPAP

May 22, 2014HME News Staff

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,...

CPAP, NGS, prepayment review


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Error rate for glucose test strips tops out

May 15, 2014HME News Staff

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...

glucose test strips, NGS, prepayment review


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Review results in 87.7% error rate for power wheelchairs

May 15, 2014HME News Staff

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...

NGS, power wheelchairs, prepayment review


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Region C RAC announces new reviews

April 3, 2014HME News Staff

WILTON, Conn. - Suction catheters for tracheostomy and speech generating devices and accessories will be subject to prepayment reviews by Connolly, the Region C RAC. For suction catheters, the company will conduct an automated review to evaluate overpayments identified when claims billed for suction catheters were not done in accordance with the billing requirements outlined in local coverage determinations (LCDs). The review of speech generating devices and accessories is a complex review evaluating...

prepayment review, region c rac


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CGS launches manual wheelchair review

February 20, 2014HME News Staff

NASHVILLE, Tenn. - High strength, lightweight manual wheelchairs will be the subject of a service-specific prepayment review because of their high claims payment error rate, CGS, the Jurisdiction C DME MAC, announced Feb. 18. Additional documentation required for K0004 claims may include: detailed written orders; medical records showing the beneficiary meets general manual wheelchair coverage criteria and one of the two K0004 code specific criteria; documentation of an assessment showing the beneficiary's...

CGS, manual wheelchair, prepayment review


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DME MAC puts nebulizers under review

November 1, 2013HME News Staff

INDIANAPOLIS - National Government Services, the Jurisdiction B DME MAC, plans to conduct a widespread prepayment review of nebulizers, related drugs, accessories and dispensing fees, it announced Oct. 29. The review is an expansion of a documentation review now being conducted on oxygen equipment and glucose supplies. Suppliers of selected claims will receive a request in the mail asking for copies of the signed and dated detailed written order, applicable dispensing orders, records supporting medical...

jurisdiction b dme mac, National Government Services, nebulizers, prepayment review


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News

In brief: Gov't delays hearings, Cardinal highlights AssuraMed

November 1, 2013HME News Staff

WASHINGTON - The Office of Medicare Hearings and Appeals (OMHA) will defer assignments for hearings—possibly up to 28 months, according to a recent notice. Requests for hearings received after July 15, 2013, will be entered into the agency's case processing system and held until there is room on an Administrative Law Judge's (ALJ) docket for adjudication. When a request is assigned, a notice will be sent, according to the notice. The ALJs have been backlogged for more than a year, thanks...

aahomecare, aahomecare manufacturers working group, AssuraMed, BOC, Cardinal Health, CareTouch, CMS, Convaid, CPAP, dead beneficiaries


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Reviews underway for oxygen, neb meds

October 22, 2013HME News Staff

FARGO, N.D. - Noridian, the Jurisdiction D DME MAC is conducting prepayment reviews of oxygen and oxygen equipment claims, and compliance reviews of neb-med claims. For the period July 2013 through October 2013, Noridian found a potential improper payment rate of 65% on E0439 claims, and a potential improper payment rate of 69% on E0434 claims. In both cases, most denials were because physician signatures were dated after the date of service, or a verbal/dispensing order was not provided. Noridian...

jurisdiction D DME MAC, noridian, prepayment review


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