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Bid winners in the off-the-shelf bracing category should be wary of lead-generation services
Bid winners in the off-the-shelf bracing category should be wary of lead-generation services

By Wayne van Halem, President, The van Halem Group Direct-to-consumer marketing and lead-generation are perfectly legal manners in which to court...

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Bid winners in the off-the-shelf bracing category should be wary of lead-generation services
Bid winners in the off-the-shelf bracing category should be wary of lead-generation services

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...

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CMS new demonstration project to include Nurse Practitioners as Certifying Physicians for Therapeutic Shoes and Inserts

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...

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Acceptable Testing for NIV patients

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...

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CMS extends contract offers for competitive bidding; removes all categories but two

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...

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OCR recoups over $10M in one week

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...

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CGS adds Urological Supplies to their widespread postpayment audits

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...

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CGS Complex Post-Pay Medical Reviews on Knee Orthotics and Surgical Dressings

By Sandra Gauron, Appeals Coordinator CGS announced that they will be conducting complex post-pay medical reviews on specific knee orthoses (L1833, L1851) and surgical dressing (A6196, and A6212) codes.  These codes have been selected based on...

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RAC adds Continuous Glucose Monitors and Supplies to their approved issues list

CMS has approved two new topics for the DMEPOS RAC, Performant, to begin reviewing, effective September 8, 2020. Continuous Glucose Monitor: Medical Necessity and Documentation Requirements Description: Documentation will be reviewed to determine...

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RAC to resume audit activities

In letters mailed to suppliers and providers last week, Performant RAC provided notification that, per CMS authorization, certain medical review activities would again resume. Additionally, the notification provides an additional 30 days to submit discussion...

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Did the DME MAC reveal first codes up for post-pay review?

Earlier today in a Listserv announcement, CGS announced that the Jurisdiction B Medical Review department would begin complex post-pay service-specific reviews on two codes: L0650 and A4253. Both reviews are a result of data analysis that indicate Jurisdiction...

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