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CMS allows multi-function vent for upgrade

By Carrie Nienberg, RN, Director of Clinical Operations Effective immediately, you as a supplier may provide and bill E0467, multi-function ventilator, as an upgrade when the beneficiary only qualifies for the ventilator. Until now, the beneficiary...

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SMRC To Perform Data Analysis and Reviews of Oxygen and Oxygen Equipment During Noncovered SNF Stays

By Sandra Gauron, Appeals Coordinator Pursuant to the Office of the Inspector General (OIG) report (OEI 06-16-00380), in which the OIG identified potential inappropriate payments to DME suppliers during non-covered SNF stays, CMS has tasked the SMRC...

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Are inhalation drugs the next OIG Six Year Lookback Audit?

Since 2010, the CMS’s Comprehensive Error Rate Testing (CERT) program has identified nebulizers and related drugs (i.e., inhalation drugs) among the top 20 supplies with the highest improper Medicare payments. Based on prior reviews, the Office of...

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PAP Supplies added to OIG Work Plan: What You Need to Know

By Sandra Gauron, Appeals Coordinator Part of the Office of Inspector General's (OIG) objectives are to promote economy and efficiency and to detect and prevent fraud, waste and abuse.  In order to do this, they develop and continually update their...

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Preventing Replacement Positive Airway Pressure (PAP) Supply claim denials

By Donna Youngblood RN, BSN, CPC There are many different scenarios for patients requiring replacement PAP supplies. Common scenarios include the need for new supplies during the 13-month rental after initiation of PAP therapy, needing supplies for...

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Is Polysomnogram Scoring a concern for you?

By Donna Youngblood RN, BSN, CPC If you are a supplier that dispenses Positive Airway Pressure (PAP) devices and/or supplies then you should be familiar with the Local Coverage Determination (LCD) that includes coverage criteria for PAP therapy. The...

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POLYSOMNOGRAPHY SERVICES AND OIG REPORT FINDINGS

By Donna Youngblood, RN, Clinical Consultant The Office of Inspector General (OIG) released a report (June 2019) regarding billed polysomnography services and denied claims. Medicare coverage for polysomnography services includes a diagnostic sleep...

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Correct Billing: PAP Devices

By Donna Youngblood, RN, Clinical Consultant A joint DME MAC article was released on 05/16/19 with long awaited guidance on billing procedures after a failed 12-week PAP trial. This guidance instructs suppliers on the correct use of the KX modifier...

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SMRC (finally) adds PAP Supplies to Current Projects list

On February 20, 2019, the Supplemental Medical Review Contractor (SMRC) Noridian Healthcare Solutions, published project "01-010 Replacement PAP Device Supplies and Accessories Notification of Medical Review" to their current projects list. While...

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CMS Releases Clinical Templates to Assist in Provider Documentation

By Donna Youngblood, RN, BSN, CPC In April 2018, CMS released their latest drafts of DMEPOS templates and suggested Clinical Data Elements (CDE) for clinical providers. These templates provide all required elements CMS is looking for related to coverage...

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