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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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National Provider Enrollment (NPE) DMEPOS Transition Starts Today!

Effective today, November 7, 2022, DMEPOS suppliers will be required to submit enrollment applications to either the NPE East (Novitas Solutions) or NPE West (Palmetto GBA) contractors. DMEPOS activities for suppliers located east of the Mississippi River...

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Updating your general liability insurance? You may need to change the certificate holder!

On Thursday, September 29, 2022, CMS formally announced the transition from the National Supplier Clearinghouse (NSC) to two new National Provider Enrollment Contractors (NPEC), Novitas Solutions (NPEast) and Palmetto GBA (NPWest). The contract...

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CMS announces the elimination of CMNS and DIFs

In the weekly CMS MLN Newsletter published Thursday, May 5, 2022, CMS announced,  “Suppliers, billers, and vendors: Certificates of medical necessity (CMNs) and the durable medical equipment (DME) information forms (DIFs) are discontinued...

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CMS Updates to Lists Related to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Conditions of Payment [CMS-6081-N]

By Donna Youngblood, RN, Clinical Consultant at The van Halem Group CMS released its long awaited Master List on January 12, 2022 with new codes being added to both the Master list and Required List. In addition, they have added Power Operated Vehicles...

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Billing supplies as an upgrade

By Carrie Nienberg, Clinical Director at The van Halem Group Did you know you could use the upgrade modifiers when billing for supplies provided to a beneficiary that exceeds the allowed amount specified in the Local Coverage Determinations (LCD)? For...

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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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Accreditation up to date? Find out on your remittance notices beginning January 3, 2022!

To supply Medicare DMEPOS to patients and to obtain and retain a supplier billing number, suppliers must adhere to the DMEPOS supplier and quality standards and accreditation requirements. In compliance with supplier standards, all changes to...

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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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NCD changes for Home Oxygen Therapy

In a memo just released by the Centers for Medicare & Medicaid Services (CMS), it was announced that upcoming changes were coming to two separate, but medically related, National Coverage Determinations (NCDs). Changes include removing the NCD for Home...

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