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Tag: SMRC


News

Depending on the contractor, audits are very much up and running

September 4, 2020Liz Beaulieu, Editor

COLUMBIA, S.C. - Audits have started to pop up in a number of places, including more recently, from the SMRC, says Andrea Stark. “I haven't seen any posts to the SMRC website announcing new audits, but I'm starting to hear the initial murmurings from suppliers they are receiving audit requests from the SMRC that may involve vents or oxygen - indicating a respiratory related review,” said Stark, a reimbursement consultant with MiraVista. “But they're non-public audit requests so...

Andrea Stark, Audits, SMRC


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News

In brief: US joins lawsuit against Arriva, SMRC targets PAP supplies

February 22, 2019HME News Staff

NASHVILLE, Tenn. - The U.S. Justice Department has joined in a lawsuit that alleges Arriva Medical offered Medicare beneficiaries “free upgrades” of glucometers.The lawsuit, filed under the False Claims Act, also alleges that Arriva and its parent company, Alere, submitted false claims for medically unnecessary glucometers, and paid kickbacks to beneficiaries in the form of free glucometers and co-pay waivers.Additionally, it alleges Arriva made no meaningful effort to collect co-pays...

aahomecare, Arriva Medical, PAP supplies, SMRC


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Also Noted

SMRC adds PAP supplies to to-do list

February 21, 2019HME News Staff

WASHINGTON - Noridian Healthcare Solutions, the Supplemental Medical Review Contractor, has added PAP supplies to its review list. The audit is a post-payment review of claims for dates of service from Jan. 1, 2017, through Dec. 31, 2017, according to a blog from the van Halem Group. The Office of Inspector General previously found that Medicare allowed replacement of PAP supplies more frequently than was reasonable and necessary; and that DME suppliers often did not have the required documentation....

CPAP Supplies, SMRC


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News

SMRC: Noridian is in, StrategicHealthSolutions is out

May 11, 2018Liz Beaulieu, Editor

FARGO, N.D. - Noridian Healthcare Solutions has taken over yet another CMS contract.The company, which is already the Medicare Administrative Contractor for jurisdictions A and D, and the Pricing Data Analysis and Coding contractor, among other things, has been awarded a $227 million contract to be the new Supplemental Medical Review Contractor.“Noridian has extensive DME experience in the field, so this is definitely in their wheelhouse,” said Andrea Stark, a reimbursement consultant...

Noridian, SMRC


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Also Noted

Noridian named new SMRC contractor

March 23, 2018HME News Staff

FARGO, N.D. - Noridian Healthcare Solutions has been awarded a $227 million Supplemental Medical Review Contractor (SMRC) contract by CMS. The primary role of the SMRC is to conduct nationwide medical review of Part A, Part B and DME providers as directed by CMS. Its responsibility is to review medical records and related documentation to ensure that claims are processed in accordance with CMS guidelines. The SMRC contract was previously held by StrategicHealthSolutions. To support the new contract,...

Audits, Medical review, Noridian, SMRC


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News

In brief: Noridian named new SMRC contractor, Bachenheimer opens DC office for Brown & Fortunato

March 23, 2018HME News Staff

FARGO, N.D. - Noridian Healthcare Solutions has been awarded a $227 million Supplemental Medical Review Contractor (SMRC) contract by CMS. The primary role of the SMRC is to conduct nationwide medical review of Part A, Part B and DME providers as directed by CMS. Its responsibility is to review medical records and related documentation to ensure that claims are processed in accordance with CMS guidelines. The SMRC contract was previously held by StrategicHealthSolutions. To support the new contract,...

Brown & Fortunato, Parachute Health, Permobil, SMRC, VGM homelink


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Also Noted

SMRC cuts providers some slack

December 9, 2016HME News Staff

WASHINGTON - SMRC contractors will give providers more time to respond to results letters, AAHomecare reported this week. The association had notified CMS that providers were being inundated with letters, and reviewing them and gathering supporting documents has been an overwhelming process. If providers need more time, they can send a written request to the SMRC for a discussion and education session within 30 days of the date of the final results letter, AAHomecare says. In their requests, providers...

aahomecare, Extensions, reviews, SMRC


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News

Regulatory review: Suspensions, overpayments and exemptions

April 15, 2016Liz Beaulieu, Editor

WASHINGTON - From a regulatory perspective, the first several months of 2016 have brought pain, and a little bit of relief, to HME providers.Among the pain points, says Wayne van Halem, is the new level of aggressiveness in the actions taken by the ZPICs. The contractors are handing out payment suspensions where, previously, they may have handed out overpayment demands, he says.“Some of the reasons for suspensions are ridiculous,” said van Halem, president of The van Halem Group. “Because...

Andrea Stark, Audits, SMRC, Wayne van Halem, zpic


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Specialty Providers

Is SMRC cherry-picking old claims?

June 6, 2014Theresa Flaherty, Managing Editor

YARMOUTH, Maine - StrategicHealthSolutions is digging deep in its latest round of post-pay reviews, industry stakeholders say: diabetes supply claims from 2011-2012.“We had to go to the pallets in the warehouse and find these,” said Marcus Suess, CEO of All-States Medical Supply in Fletcher, N.C. “We've been electronic for a while but we boxed up the EOBs—we're too busy to scan everything.”Medicare contracted with the Omaha, Neb.-based StrategicHealthSolutions to serve...

Audits, Diabetes Supplies, SMRC


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Guest Blog

Is CMS preparing for hunting season?

April 11, 2014HME News Staff

As Elmer Fudd would say “Be vewwy, vewwy quiet...I'm hunting wabbits!” The Centers for Medicare and Medicaid Services (CMS) may not be hunting rabbits, but they're hunting the very elusive greenbacks. On September 1, 2012, CMS implemented the prior authorization (PA) for power mobility devices (PMDs) demonstration in seven states: Cal., Fla., Ill., Mich., N.C., N.Y. and Texas. CMS claims that spending per month on power mobility devices in the seven demo states has decreased since September...

Audits, Prior authorization demo, RACs, SMRC


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