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Audit Alert! SMRC adds orthopedic footwear to their audit list

Noridian Healthcare Solutions, LLC, as the Supplemental Medical Review Contractor (SMRC) for the Centers for Medicare & Medicaid Services (CMS), is conducting...

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Audit Alert! SMRC adds orthopedic footwear to their audit list

Noridian Healthcare Solutions, LLC, as the Supplemental Medical Review Contractor (SMRC) for the Centers for Medicare & Medicaid Services (CMS), is conducting post-payment review of Orthopedic Footwear claims from January 1, 2019 through December 31,...

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Accreditation up to date? Find out on your remittance notices beginning January 3, 2022!

To supply Medicare DMEPOS to patients and to obtain and retain a supplier billing number, suppliers must adhere to the DMEPOS supplier and quality standards and accreditation requirements. In compliance with supplier standards, all changes to...

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Audit Alert! SMRC and RAC add surgical dressing, ostomy and nutrition to their audit lists

Noridian Healthcare Solutions, the Supplemental Medical Review Contractor (SMRC), has added two new DMEPOS items to their current projects lists: surgical dressings and ostomy supplies. Noridian will be conducting post-payment review of claims...

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OMHA announces online appeals submission

The Office of Medicare Hearings and Appeals (OMHA) announced today that appellants can now file  Level 3 Medicare appeals online. As of December 15, 2021, the OMHA e-Appeal Portal (Portal) is now available, allowing you to: Securely...

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Hospice Audits to Increase

In mid-November, the OIG published a report highlighting improper payments for DMEPOS provided to hospice beneficiaries. Officially titled “Medicare Improperly Paid Suppliers an Estimated $117 Million over 4 Years for Durable Medical Equipment,...

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NCD changes for Home Oxygen Therapy

In a memo just released by the Centers for Medicare & Medicaid Services (CMS), it was announced that upcoming changes were coming to two separate, but medically related, National Coverage Determinations (NCDs). Changes include removing the NCD for Home...

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Reminder: Payment edits for custom fitted orthotics go in effect October 1, 2021

Effective for dates of service on or after October 1, 2021, if a supplier is located in one of the states listed below and wishes to bill Medicare for certain orthoses coded as OR01 (Orthoses: Custom Fabricated) and OR02 (Orthoses: Prefabricated, Custom...

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Settlement Conference Facilitation Expansion 2021

By Sandra Gauron, Appeals Coordinator The Centers for Medicare & Medicaid Services (CMS) has provided an alternative dispute resolution to filing an appeal to an Administrative Law Judge (ALJ) in order to prevent backlog since July 2014. The Settlement...

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Provider Enrollment Activities to Resume

In this week’s MLN Matters Newsletter, CMS announced that, beginning October 2021, some provider enrollment activities that were paused during the COVID-19 public health emergency will resume, including: Application Fees  Criminal...

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CMS announces TPE audits to resume

In the most recent issue of the CMS MLN Connects Newsletter, CMS announced that they are restarting the Targeted Probe and Educate (TPE) program. The program, which was established with a goal to “help educate providers and reduce...

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