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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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OMHA Further Expands the Settlement Conference Facilitation Parameters

By Sandra Gauron, Audit and Appeals Coordinator In an effort to provide Administrative Law Judge (ALJ) backlog relief, CMS launched the Settlement Conference Facilitation (SCF) pilot program in July 2014.  SCF is an alternative dispute resolution...

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Minor Claim Processing Error…… What is the next step?

By Kim Turner, RN No matter how careful, Medicare claim mistakes will happen. When they do, your claim may not be able to be processed by the DME MAC. Listed below are some common errors which prevent your claim from being processed. If you find a...

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Avoiding Same or Similar Claim 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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OMHA Reduces ALJ Backlog

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...

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DME QIC Appeals Update

Effective September 1, 2019, MAXIMUS Federal will serve as the DME QIC for the entire United States and the U.S. territories. This means that any requests for reconsiderations received on or after September 1, 2019 will be processed by MAXIMUS. With...

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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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Court orders HHS to clear Medicare appeals backlog by 2022

On November 1, 2018 a judge ruled that the Department of Health and Human Services (HHS) must eliminate the Medicare appeals backlog by 2022. At the time of the ruling, there were more than 426,000 unresolved Medicare disputes. While the backlog must...

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DME QIC expands options to Jurisidictions A and B claims

On Tuesday, October 22, 2018, CMS announced that they would expand the QIC Demonstration into DME MAC Jurisdictions A and B. Effective on or after November 1, 2018, the DME QIC will offer telephone discussions and/or reopenings to DME suppliers within...

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