The Affordable Care Act takes historic steps toward combating health care fraud, waste and abuse by providing critical new tools to crack down on entities and individuals attempting to defraud Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and private insurance plans. The Centers for Medicare & Medicaid Services (CMS) is using state-of-the-art technology review [...]
Product Labeling Requirements Rescinded – Effective Immediately
PDAC has rescinded the requirements for product labeling as outlined in the article titled Product Labeling and Product Sample Requirements for Coding Verification that was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. [...]
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 [...]
DJO Global Orthotic Fitter Course
DJO Global is proud to announce the April 11-14, 2011 DJO: Orthotic Fitter Course. This course is an ABC and BOC approved entry-level educational course for any practitioner wishing to become a Certified Orthotic Fitter (COF). This course provides a wonderful balance between lecture and laboratory experiences. Anatomy, physiology of injury, and symptoms requiring brace [...]
Lower Limb Orthoses – Coverage Criteria and Physician Documentation Requirements
A letter from Stacey V. Brennan, M.D., FAAFP Medical Director, DME MAC, Jurisdiction B to physicians. Dear Physician, Leg braces are covered by Medicare when they are required to support the limb and/or restrict or eliminate motion of a joint because of disease, injury, congenital condition, or orthopedic surgical procedure. Although elastic supports may be [...]
The Centers for Medicare & Medicaid Services (CMS) has released a modification to the Healthcare Common Procedure Coding System (HCPCS) code set.
CMS has reinstated codes L3660 “SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT”; L3670 “SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT”; and L3675 “SHOULDER ORTHOSIS, VEST TYPE ABDUCTION RESTRAINER, CANVAS WEBBING TYPE OR EQUAL, PREFABRICATED INCLUDES FITTING AND ADJUSTMENT” with the original [...]
Internet-based Provider Enrollment, Chain and Ownership System (PECOS) For Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Suppliers
DMEPOS suppliers can use Internet-based PECOS to enroll, make a change in their enrollment record, view their Medicare enrollment information on file with Medicare, and check on the status of a Medicare enrollment application via the Internet. Using Internet-based PECOS: Before you begin to use Internet-based PECOS, you: Should review the document titled, “Internet-based PECOS [...]
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