Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in Fiscal Year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies [...]
Product Labeling Requirements Rescinded – Effective Immediately
PDAC has rescinded the requirements for product labeling as outlined in the article titled Product Labeling and Product Sample Requirements for Coding Verification that was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. [...]
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 [...]
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 [...]
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. [...]
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 [...]
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 [...]
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 [...]
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 [...]
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. [...]
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