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CMS issues guidance on post PHE audits

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...

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Heartland Sneak Peek: COVID Flexibilities Are Now Audit Opportunities

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”...

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The Return of the RACs

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. ...

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RAC updates ADR limits

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...

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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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