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RAC Audit Alert - Pneumatic Compression Devices

Performant Recovery posted one new automated issue to their approved issues log this month. Pneumatic Compression Devices On January 23, 2019, Performant Recovery, the National DMEPOS RAC, added Pneumatic Compression Devices to their approved...

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Developing Best Practices for the New Year - Performing a HIPAA Risk Assessment

What is a HIPAA Risk Assessment? In 2003, the original HIPAA Privacy Rule was issued, and the requirement to have a HIPAA Risk Assessment was put in place. However, many entities did not comply. Since the Office of Civil rights is issuing fines and...

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Proof of Delivery Requirements

In November 2017, CMS issued Change Request CR10324, which simplified the Proof of Delivery (POD) requirements. The change request touched on three specific areas: initial delivery, newly eligible beneficiaries, and compliance with the POD Requirements....

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Developing Best Practices for the New Year - Good Documentation Resolutions for 2019

At the beginning of the New Year most of us make resolutions. Whether it is for health, exercise, fiscal or general life improvements, resolutions can be good for us. Resolutions for documentation can be beneficial too. Whether you are adhering to a...

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Developing Best Practices for the New Year – A Strong Intake Process

By Donna Youngblood, RN, BSN, CPC The CERT program released a report for the 2018 Medicare FFS National Improper Payment Rate for DMEPOS. The data was pulled from claims submitted during the 12-month period from July 1, 2016 through June 30, 2017 and...

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CMS continues to enhance TPE Program with a 10-claim review pilot

On December 31, CMS implemented the TPE 10-Claim Preview Pilot, which is intended to further reduce burden for compliant DME suppliers, according to AA Homecare. The new 10-claim pilot allows for MACs to select 10 claims for TPE Round 1 for review. If...

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Developing Best Practices for the New Year – Avoiding Same or Similar Denials

By Donna Youngblood, RN, BSN, CPC Same or similar denials occur when claims information is checked against the patient’s CMN history. This will indicate when equipment is “same or similar” to that piece of equipment being billed on the claim....

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CMS quietly updates TPE terms

On November 28, 2018, CMS rescinded and replaced Transmittal 1919 with 2207 to clarify language that more accurately instructs MACs on subsequent rounds of the Targeted Probe and Education (TPE) initiative. Specifically, CMS advised MACs that the...

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RAC AUDIT ALERT: Spinal Orthosis (TLSO/LSO) within the Reasonable Useful Lifetime

Performant Recovery posted one new automated issue to their approved issues log this month. Spinal Orthosis (TLSO/LSO) within the Reasonable Useful Lifetime On January 1, 2019, Performant Recovery, the National DMEPOS RAC, added Spinal Orthosis...

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Developing Best Practices for the New Year - Continued Medical Need of DMEPOS

By Donna Youngblood, RN, BSN, CPC If you are providing capped rental DME items or dispensing consumable/non-consumable supplies, there must be information in each patient’s medical record to support that the item continues to remain reasonable and...

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