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FDA releases safety information related to the Philips recall

On June 30, 2021, the U.S. Food and Drug Administration (FDA) published a safety communication to their website. The FDA communication urges patients using the affected devices to talk to their health care providers to determine a suitable treatment...

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Updates to Glucose Monitor LCD and Policy Article
Updates to Glucose Monitor LCD and Policy Article

The FUTURE Local Coverage Article: Glucose Monitor - Policy Article (A52464) and FUTURE Local Coverage Determination (LCD): Glucose Monitors (L33822) are now available for viewing on the CMS website. While most of the edits are minor changes to verbiage,...

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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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Provide Custom Fabricated or Prefabricated (Custom Fitted) Orthotics? You may need to update your enrollment file!

CMS issued CR 12282 to communicate the addition of HCPCS codes that require the use of a licensed/certified orthotist or prosthetist for furnishing custom fabricated and prefabricated (custom fitted) orthoses.  This change will apply...

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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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Bid winners in the off-the-shelf bracing category should be wary of lead-generation services
Bid winners in the off-the-shelf bracing category should be wary of lead-generation services

By Wayne van Halem, President, The van Halem Group Direct-to-consumer marketing and lead-generation are perfectly legal manners in which to court potential customers. However, with Medicare patients, there are a number of laws that HME suppliers...

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CMS new demonstration project to include Nurse Practitioners as Certifying Physicians for Therapeutic Shoes and Inserts

Effective January 1, 2021 and extending through December 31, 2025, CMS is exercising its authority to allow nurse practitioners to certify that an order for diabetic shoes is required under a new model demonstration for certain states. Under this...

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CGS adds Urological Supplies to their widespread postpayment audits

CGS announced that they will be conducting complex post-pay medical reviews on urological supplies ( A4351, A4352, A4353, A4355 and A4316) codes.  These codes have been selected based on data analysis, which revealed that the allowed dollars for...

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CGS Complex Post-Pay Medical Reviews on Knee Orthotics and Surgical Dressings

By Sandra Gauron, Appeals Coordinator CGS announced that they will be conducting complex post-pay medical reviews on specific knee orthoses (L1833, L1851) and surgical dressing (A6196, and A6212) codes.  These codes have been selected based on...

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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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