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September 27, 2023 The van Halem Group has identified an increase in UPIC audit requests for CGM and supplies for both pandemic and current dates of service. The UPICs are auditing providers on both a prepayment and postpayment basis. CMS recently indicated that they wanted... July 12, 2023 Performant, the national home health, hospice, and DMEPOS recovery audit contractor (RAC), added two new items to their CMS approved audit issues list. Both are identified as complex reviews, meaning providers that bill these services could be subject... March 24, 2023 By Wayne van Halem, President, The van Halem Group
There are a number of signs that are pointing to an increase in audit activity across multiple payers as the public health emergency (PHE) winds down. These increases can be expected not just... The CMS Center for Program Integrity (CPI) posted an FAQ this week on their Spotlight page titled “Medicare Fee-for-Service Claims Review When the Public Health Emergency Ends”. From the post...
Q. At the end of the Public Health Emergency... April 27, 2022 By Wayne van Halem, President, The van Halem Group
One of the biggest uncertainties of moving into a post-pandemic world is how CMS will decide to audit claims submitted during the public health emergency. There were a number of “waivers”... By Wayne H. van Halem, AHFI, CFE, President, The van Halem Group
The Recovery Audit Contractor (RAC) Program wreaked havoc in the DMEPOS industry from 2011 until about 2015 when they were essentially given free rein to audit DMEPOS claims. ... The Centers for Medicare & Medicaid Services (CMS) announced that they have modified the additional documentation request (ADR) limits for the Medicare Fee-for-Service Recovery Audit Contractor (RAC) program for suppliers. These limits will be... 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,... 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... 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,...