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Performant Recovery posted one new automated issue to their approved issues log this month.

Pneumatic Compression Devices

On January 23, 2019, Performant Recovery, the National DMEPOS RAC, added Pneumatic Compression Devices to their approved issues list. According to their website, Performant Recovery will perform complex reviews to determine if the pneumatic compression device is reasonable and necessary for the patient’s condition based on the documentation in the medical record. Claims that do not meet the indications of coverage and/or medical necessity will be denied

Code(s) included in the audit: E0651 and E0652

Dates of service: Claims having a “claim paid date” which is more than 3 years prior to the ADR date and prior to 12/01/2015

Applicable policy references:

1. Title XVIII, Social Security, §1833(e), Section 1862(a)(1)(A)
2. Code of Federal Regulations, 42 CFR sections 405.980 (b) & (c) and section 405.986, 42 CFR; section 410.38(g)(3), 42 CFR; section 410.38(g)(4), 42 CFR; section 424.57 (12)
3. Medicare Benefit Policy Manual, Chapter 15, Section 110, Durable Medical Equipment – General
4. Medicare National Coverage Determination (NCD) Manual, (IOM) Publication 100-03, Chapter 1, Part 4, Section 280.6, Pneumatic Compression Devices
5. Medicare Claims Processing Manual, (IOM) Publication 100-04, Chapter 30 Section 50.13.4, Supplier’s Right to Recovery Resalable Items for Which Refund Has Been Made
6. Medicare Program Integrity Manual, (IOM) Publication 100-8, Chapter 4, Section 4.26, Supplier Proof of Delivery Documentation Requirements
7. Medicare Program Integrity Manual, (IOM) Publication 100-8, Chapter 5, Section 5.2.4 – 5.2.8, 5.7, 5.8, and 5.9
8. Local Coverage Determination (LCD) L33829 – Pneumatic Compression Devices; Effective 10/01/2015; Revised 01/01/2017
9. MAC Policy Article A52488 – Pneumatic Compression Devices; Effective 10/01/2015; Revised 01/01/2017
10. CMS Policy Article for Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426), Effective 1/1/2017; Revised 05/07/2018

Want some help? Come to the experts! 

The van Halem Group offers proactive and reactive services to assist you. If you receive an audit request from the RAC our clinical team will review the claim file and respond to the audit on your behalf. If denied, we will work with you to obtain addendums and appeal the overpayment.

Want to feel confident that the equipment you are providing meets coverage criteria? Sign up for our clinical prescreen review program.

Before you put out the equipment, let our clinical staff review your documentation to ensure the equipment meets coverage criteria. Our clinicians will review your documentation and provide you with an “approved” or “denied” status, along with recommendations for your referral source. Get your documentation right before you bill the claim to Medicare, and rest easy knowing you are protected should those claims be audited in the future.  In fact, we feel so confident in our clinical prescreen process, if you receive a denial on a claim that received vHG “approval”, we will appeal on your behalf – for free*! That is how confident we are in our  prescreen program.

*Claim must be submitted with same documentation provided at prescreen level. Any changes or alterations void free appeal.

Contact us for more information!