The FUTURE Local Coverage Article: Glucose Monitor - Policy Article (A52464) and FUTURE Local Coverage Determination (LCD): Glucose Monitors (L33822) are...
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June 16, 2021
The FUTURE Local Coverage Article: Glucose Monitor - Policy Article (A52464) and FUTURE Local Coverage Determination (LCD): Glucose Monitors (L33822) are now available for viewing on the CMS website. While most of the edits are minor changes to verbiage,...
DMEPOS Suppliers see spike in commercial audits
Last week CMS announced that MACs would expand their postpayment audit scope to include dates of service after March 1, 2020. Previously, MACs had been restricted to auditing pre-pandemic claims only. In addtion to increased audit activity...
June 7, 2021
CMS issued CR 12282 to communicate the addition of HCPCS codes that require the use of a licensed/certified orthotist or prosthetist for furnishing custom fabricated and prefabricated (custom fitted) orthoses. This change will apply...
June 3, 2021
Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. The...
November 23, 2020
By Wayne van Halem, President, The van Halem Group Direct-to-consumer marketing and lead-generation are perfectly legal manners in which to court potential customers. However, with Medicare patients, there are a number of laws that HME suppliers...
November 12, 2020
Effective January 1, 2021 and extending through December 31, 2025, CMS is exercising its authority to allow nurse practitioners to certify that an order for diabetic shoes is required under a new model demonstration for certain states. Under this...
November 11, 2020
Carrie Nienberg, RN, CPC, Director of Clinical Operations On August 25th, 2020, CGS conducted a webinar on the National Coverage Determination (NCD) coverage criteria and documentation requirements for ventilators. During the webinar, the following...
October 28, 2020
Late in the evening on October 27, CMS announced that they would not move forward with 13 product categories for Round 2021 DMEPOS CBP, leaving only off-the-shelf back and knee braces in certain CBAs. CMS has released the new single payment amounts...
October 19, 2020
By Kelli Ogunlesi, CHP, HIPAAwise Success Manager The last week of September proved to be a very busy one for the Office of Civil Rights (OCR), the federal agency responsible for enforcing HIPAA privacy and security rules. From September 21 through...
September 15, 2020
CGS announced that they will be conducting complex post-pay medical reviews on urological supplies ( A4351, A4352, A4353, A4355 and A4316) codes. These codes have been selected based on data analysis, which revealed that the allowed dollars for...