October 28, 2019 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.... In a status report published late last month, the Office of Medicare Hearings and Appeals (OMHA) revealed a reduction in the appeals backlog by 25%.
The OMHA has been actively working to reduce the appeals backlog, from a record high of 886,418 appeals... October 21, 2019 By Sandra Gauron, Appeals Coordinator
Part of the Office of Inspector General's (OIG) objectives are to promote economy and efficiency and to detect and prevent fraud, waste and abuse. In order to do this, they develop and continually update their... October 21, 2019 By Donna Youngblood RN, BSN, CPC
Do you find it difficult to explain to your referral source how to properly amend a patient's medical record, particularly after the document has been signed? The van Halem Group is aware of this challenge and has... October 18, 2019 By Kim Turner, RN
A Continuous Glucose Monitor device (CGM), HCPCS K0554, is covered by Medicare under the DME benefit. When a therapeutic CGM is covered, the related supply allowance (code K0553, SUPPLY ALLOWANCE FOR CGM, INCLUDES ALL SUPPLIES AND... October 14, 2019 By Kim Turner, RN, Clinical Consultant
By now as a complex rehab supplier, you are likely familiar with the Medicare Condition of Payment Prior Authorization (PA) for the eligible power mobility device codes K0813-K0829 and K0835-K0855, K0856, and... October 7, 2019 By Donna Youngblood, RN, BSN, CPC
If you are dispensing consumable/non
consumable supplies or rented DME items are being used by patients, there must
be information in each patient’s medical record to support that the item
continues to remain reasonable... October 4, 2019 By Kim Turner, RN
When billing Medicare, the billing modifiers can be alphabetic,
numeric or a combination of both, but will always be two digits for Medicare
purposes. Some modifiers cause automated pricing changes, while others are used
to convey...
Avoiding Same or Similar Claim Denials
OMHA Reduces ALJ Backlog
PAP Supplies added to OIG Work Plan: What You Need to Know
Do’s and Don’ts: Amending a Medical Record
DME MACs report an increase in denials for the HCPCS code K0553
What does an affirmed Medicare prior authorization for a power wheelchair really mean?
Documenting Continued Medical Need of DMEPOS
RA or RB Billing Modifier…..when to use?
