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audits

OMHA expands eligibility for settlements

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08/13/2020

WASHINGTON – The Office of Medicare Hearings and Appeals has extended the eligibility requirements to participate in a Settlement Conference Facilitation

CGS announces reviews for back braces, glucose monitors

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08/13/2020

ATLANTA – CGS has announced that the Jurisdiction B medical review department will begin complex post-pay service-specific reviews on back braces and lithium batteries for glucose monitors, according to the van Halem Group.

Post-pay reviews get start date

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08/07/2020

WASHINGTON – The DME MACs will resume medical reviews Aug. 17, according to a bulletin from CMS.

A new, but temporary, era in audits

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07/24/2020

WASHINGTON – Industry stakeholders now have a better idea of CMS’s plans for restarting program integrity activities on Aug. 3, but they still have questions, like what product categories will get audited.

Audits will not resume full bore

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07/21/2020

WASHINGTON – When program integrity activities resume on Aug. 3, CMS will not be auditing claims started during the public health emergency, industry stakeholders have learned.

CMS reinstates audits, prior auths

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07/10/2020

WASHINGTON – Starting Aug. 3, auditors will restart their audit functions, according to a recently published FAQ from CMS.

CMS adds CERT to reviews that are suspended

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04/14/2020

WASHINGTON – CMS will pause its CERT program, and will not send documentation request letters to or conduct phone calls with providers until further notice, according to AAHomecare

AAH reports numerous updates on coronavirus and HME

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03/24/2020

WASHINGTON – CMS recently updated its COVID-19 FAQ to include coverage for home oxygen for patients diagnosed with the disease.

CPAP supplies: OIG adds another layer of scrutiny

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11/01/2019

WASHINGTON – Providers who get request letters from the Office of Inspector General for documentation for CPAP replacement supplies need to take them seriously, because there could be a lot of money at stake, say industry stakeholders.

Auditors avoid appeals process, make ‘major’ requests

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09/13/2019

YARMOUTH, Maine – If you’re an HME provider trying to appeal a denial by a managed care payer, it’s probably not going very smoothly, reports consultant Wayne van Halem.

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