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By Donna Youngblood, RN, Clinical Consultant The Office of Inspector General (OIG) released a report (June 2019) regarding billed polysomnography services and denied claims. Medicare coverage for polysomnography services includes a diagnostic sleep...

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RAC Audit Alert: Blood Glucose Test or Reagent Strips

Performant Recovery posted one new complex issue to their approved issues list. Blood Glucose Test or Reagent Strips (A4353) On June 14, 2019, Performant Recovery, the National DMEPOS RAC, added blood glucose test or regeant strips (A4353)...

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OMHA Expands the Settlement Conference Facilitation

By Sandra Gauron, Appeals Coordinator In an effort to provide ALJ backlog relief, CMS launched the Settlement Conference Facilitation (SCF) pilot program in July 2014.  SCF is an alternative dispute resolution process designed to bring the appellant...

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Avoid an Unprocessable Medicare Claim Denial

On December 6, 2018, the DME MACs issued a joint publication notifying suppliers of a change in the way to bill for bilateral products dispensed on the same day. Previously, when two of the same items are given to patients for use on both limbs, the...

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CMS provides details on prior authorization for support surfaces

In a recent Special Open Door Forum CMS provided more details for the pressure reducing support surfaces prior authorization program. Beginning on July 22, providers in four states will have to submit prior authorization requests for five support surface...

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