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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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Audit Alert! SMRC and RAC add surgical dressing, ostomy and nutrition to their audit lists

Noridian Healthcare Solutions, the Supplemental Medical Review Contractor (SMRC), has added two new DMEPOS items to their current projects lists: surgical dressings and ostomy supplies. Noridian will be conducting post-payment review of claims...

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Hospice Audits to Increase

In mid-November, the OIG published a report highlighting improper payments for DMEPOS provided to hospice beneficiaries. Officially titled “Medicare Improperly Paid Suppliers an Estimated $117 Million over 4 Years for Durable Medical Equipment,...

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CMS announces TPE audits to resume

In the most recent issue of the CMS MLN Connects Newsletter, CMS announced that they are restarting the Targeted Probe and Educate (TPE) program. The program, which was established with a goal to “help educate providers and reduce...

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DMEPOS Suppliers see spike in commercial audits

Last week CMS announced that MACs would expand their postpayment audit scope to include dates of service after March 1, 2020. Previously, MACs had been restricted to auditing pre-pandemic claims only.  In addtion to increased audit activity...

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MACs Resume Medical Review on a Post-payment Basis

Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. The...

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