Product Labeling Requirements Rescinded – Effective Immediately
PDAC has rescinded the requirements for product labeling as outlined in the article titled Product Labeling and Product Sample Requirements for Coding Verification that was posted to the PDAC website on September 22, 2011 and the revision article posted on December 19, 2011. All articles and related references have been removed from the PDAC website. Please click here for more information PDAC
CODING GUIDELINES FOR ANKLE FOOT ORTHOSES
Recently the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and the Pricing Data Analysis & Coding (PDAC) contractor received questions regarding coding guidelines for Ankle Foot Orthosis. In an effort to address these questions, the following definitions for certain orthoses will clarify their meaning and assist suppliers in correct coding of these devices.
Please click here for more information CODING GUIDELINES
Reminder: Start Using the Revised CMS-855S Enrollment Application
DMEPOS suppliers are reminded that the CMS-855S enrollment application was recently revised to capture additional information pertinent for enrollment processing. Suppliers should use the CMS-855S version (07/11) if enrolling in Medicare for the first time, reporting changes to existing enrollment, if you have been asked to revalidate your existing enrollment, and other limited circumstances.
The 07/09 version of the CMS-855S will only be accepted through December 31, 2011. Any information received on the obsolete form after this point will be returned to the supplier resulting in a delay to your enrollment activities.
Download and begin using the revised version today by accessing the forms by clicking here: CMS Forms
2012 DMEPOS FEE SCHEDULE
2012 DMEPOS FEE SCHEDULE
The DMEPOS fee schedules are updated on an annual basis in accordance with statute and regulations. The update process for the DMEPOS fee schedule is located in Pub.100-04, Medicare Claims Processing Manual, chapter 23, section 60B. Policy: This recurring update notification provides instructions regarding the 2012 annual update for the DMEPOS fee schedule. Payment on a fee schedule basis is required for durable medical equipment (DME), prosthetic devices, orthotics, prosthetics, and surgical dressings by §1834(a), (h), and (i) of the Social Security Act. Please click here for 2012 Fee Schedule.
2010 Recovery Audit Program Results
FY 2010 was the first year in which the Recovery Auditors (RAC) began actively identifying and correcting
improper payments under the National Recovery Audit program. All the Recovery Auditors began
reviewing claims in October 2009. In the past fiscal year, the Recovery Auditors identified and corrected
$92.3 million in combined overpayments and underpayments. Eighty-two percent of all Recovery Audit
program corrections were collected overpayments, and 18 percent were identified underpayments that
were refunded to providers. $18.8 million in Medicare overpayments were collected for durable medical equipment.
For more information, please click here for the entire report RAC REPORT
PDAC LETTERS FOR DJO PRODUCTS
If you are looking for PDAC letters for DJO products, they can be found on the DJO Corporate Compliance website at: http://www.djoglobal.com/en_US/Coding.html
If the product you are looking for is not listed there, it means that DJO has not submitted a PDAC application for that particular product, or has not yet received a PDAC letter in response to an application. All PDAC letters are posted immediately upon receipt. Please be advised that DJO has obtained PDAC letters where required – which includes all knee braces coded L1845 and all rigid back braces. (As of September 1, 2011, PDAC letters will be required for cervical collars coded L0174.)
Questions about PDAC letters should be directed to the appropriate DJO marketing manager or to corporate.compliance@djoglobal.com.
NEXT STEPS FOR EXPANSION OF THE MEDICARE DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES COMPETITIVE BIDDING PROGRAM
The Centers for Medicare & Medicaid Services (CMS) today announced plans to expand the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. This program is an essential tool to help Medicare set appropriate payment rates for DMEPOS items and services. Except in nine areas of the country where the program is now in effect for certain items, Medicare pays for DMEPOS items using a fee schedule that is generally based on historic supplier charges from the 1980s, increased by an annual covered item update factor. Numerous studies from the Department of Health and Human Services Office of Inspector General and the Government Accountability Office have shown that the fee schedule amounts for certain DMEPOS items are excessive; taxpayers and Medicare beneficiaries bear the burden of these excessive payments.
View the HEAT Provider Compliance Training Webcast
Hear from the Office of Inspector General and other government experts as they educate local health care providers, compliance officers, and their legal counsel about the realities of Medicare fraud and the importance of implementing an effective compliance program.
- Get the Facts. Understand the law and the consequences of violating it.
- Make a Plan. Cultivate a culture of compliance within your health care organization.
- Know Where to Go. Learn what to do when a compliance issue arises.
This free compliance training is offered by the U.S. Department of Health and Human Services, Office of Inspector General. No registration is required to view this event. Please follow this link for more information HEAT
Effective March 25, 2011: Implementation of Provider Screening and Risk Based Categories for Provider/Supplier Enrollment
It is the continuing goal of the Centers for Medicare & Medicaid Services (CMS) to reduce fraud, waste, and abuse through all available avenues. The Affordable Care Act requires CMS to determine the level of screening to be conducted during provider and supplier enrollment based on the level of risk posed to the Medicare system. With the enactment of the Affordable Care Act, we have the increased ability to focus our efforts on prevention, rather than simply acting after the fact. The use of risk categories and associated screening levels will help ensure that only legitimate providers and suppliers are enrolled in Medicare, Medicaid, and CHIP, and that only legitimate claims are paid.
Effective Friday, March 25, 2011, newly-enrolling and revalidating providers and suppliers will be placed in one of three screening categories – limited, moderate, or high. These categories represent the level of risk for fraud, waste, and abuse to the Medicare program for the particular category of provider/supplier, and determine the degree of screening to be performed by the Medicare Administrative Contractor (MAC) processing the enrollment application. For more information please click here: CMS Please refer to the regulation published to the Federal Register
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