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CMS announces the elimination of CMNS and DIFs

In the weekly CMS MLN Newsletter published Thursday, May 5, 2022, CMS announced,  “Suppliers, billers, and vendors: Certificates of medical...

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Recent Blog Posts

CMS announces the elimination of CMNS and DIFs

In the weekly CMS MLN Newsletter published Thursday, May 5, 2022, CMS announced,  “Suppliers, billers, and vendors: Certificates of medical necessity (CMNs) and the durable medical equipment (DME) information forms (DIFs) are discontinued...

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Heartland Sneak Peek: COVID Flexibilities Are Now Audit Opportunities

By Wayne van Halem, President, The van Halem Group One of the biggest uncertainties of moving into a post-pandemic world is how CMS will decide to audit claims submitted during the public health emergency. There were a number of “waivers”...

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PHE Extended Another 90 Days

On Tuesday, April 12, 2022, HHS Secretary Xavier Becerra announced an extension of the COVID-19 Public Health Emergency (PHE). This extension will last another 90 days from April 16, 2022. Any PHE declaration can only last for 90 days at a time...

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The Return of the RACs

By Wayne H. van Halem, AHFI, CFE, President, The van Halem Group The Recovery Audit Contractor (RAC) Program wreaked havoc in the DMEPOS industry from 2011 until about 2015 when they were essentially given free rein to audit DMEPOS claims. ...

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RAC updates ADR limits

The Centers for Medicare & Medicaid Services (CMS) announced that they have modified the additional documentation request (ADR) limits for the Medicare Fee-for-Service Recovery Audit Contractor (RAC) program for suppliers. These limits will be...

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DOJ recovered over $5.6 Billion in 2021 – Over $5B related to health care industry

On February 1, 2022, the Department of Justice (DOJ) announced on their website that they had obtained more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending...

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CMS Updates to Lists Related to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Conditions of Payment [CMS-6081-N]

By Donna Youngblood, RN, Clinical Consultant at The van Halem Group CMS released its long awaited Master List on January 12, 2022 with new codes being added to both the Master list and Required List. In addition, they have added Power Operated Vehicles...

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Billing supplies as an upgrade

By Carrie Nienberg, Clinical Director at The van Halem Group Did you know you could use the upgrade modifiers when billing for supplies provided to a beneficiary that exceeds the allowed amount specified in the Local Coverage Determinations (LCD)? For...

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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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