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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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Did the DME MAC reveal first codes up for post-pay review?

Earlier today in a Listserv announcement, CGS announced that the Jurisdiction B Medical Review department would begin complex post-pay service-specific reviews on two codes: L0650 and A4253. Both reviews are a result of data analysis that indicate Jurisdiction...

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MACs Medical Review get official start date

Today, CMS released more details on the medical review program since announcing audits would resume on August 3. This week's CMS MLN Connects newsletter included the headline "MACs Resume Medical Review on a Post-Payment Basis". In the article, it...

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More details on Medicare Audits beginning August 3

In recent meetings with CMS, we have learned that while the date to begin medical review functions is August 3rd, there will likely be a delayed time frame before audit requests officially go out. CMS is currently working to develop instructions for...

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CMS directs auditors to get back to it on August 3; Prior Auth programs get the greenlight too

In the most recently published Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs) a question related to the suspension of medical review leads the list of FAQs. The question, in it's entirety reads as follows,...

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Continued Need for Supplies

By Carrie Nienberg, RN, Director of Clinical Operations Did you know ongoing continued need isn’t required for urological or ostomy supplies? In the ostomy policy article, under continued need it indicates once initial medical need is established,...

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