Effective for dates of service on or after November 17, 2012, Healthcare Common Procedure Coding System (HCPCS) code L0430 (SPINAL ORTHOSIS, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH INTERFACE MATERIAL, CUSTOM FITTED (DEWALL POSTURE PROTECTOR ONLY)) will be invalid for claim submission to the… Read More ›
Tag Archive for ‘Medicare’
Results of Widespread Prepayment Probe Review of Spinal Orthoses (HCPCS L0631 and L0637)
Review Results Jurisdiction D DME MAC Medical Review Department completed a widespread prepayment probe review of HCPCS codes L0631 and L0637. This review was initiated based on reason for review by CERT analysis. The L0631 review involved 101 claims of… Read More ›
SENIOR MEDICARE PATROL, THE NEW WATCHDOG
In 2011, the 54 Senior Medicare Patrol Projects had 5,671 active volunteers, a 14-percent increase from 2010. These volunteers conducted 66,303 one-on-one counseling sessions and 11,109 group education sessions. In 2011, 431,128 beneficiaries attended group education sessions, an increase from… Read More ›
NOTIFICATION OF PREPAYMENT REVIEW FOR ORTHOTIC AND PROSTHETIC HCPCS CODES
NAS Jurisdiction D DME MAC Medical Review will be initiating a widespread prepayment probe review of claims for each of the following HCPCS codes: L0631, L0637, L0830, L4360, L1960, and L1970. This review is being initiated based on the results of Comprehensive Error Rate Testing (CERT)… Read More ›
DME MAC REGIONS DELETE PDAC CODING VERIFICATIONS FOR AFO CODES
Effective immediately, Medicare Regions A,B,C, and D have deleted the Coding Verification Review that was made by PDAC July 1, 2012 on products billed with codes L1906, L1930, L1932, L1940, L1960, L1970 and L1971. For more information on the deleted… Read More ›
Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion
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… Read More ›
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… Read More ›
Tougher Health Fraud Prevention Measures Proposed
The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule that would implement new anti-fraud measures on physicians and medical suppliers. The proposed rule carries out provisions of the Patient Protection and Affordable Care Act. The proposal… Read More ›
DJO Receives PDAC Letters for DonJoy Back Braces!
DJO has received PDAC letters for its DonJoy Back Braces. These rigid braces have been assigned covered codes and are eligible for reimbursement from Medicare. To view the PDAC letters and the assigned HCPCS codes for each product, please click… Read More ›
PECOS update-Twenty minutes with CMS’s Jim Bossenmeyer
BALTIMORE – Coming off last week’s confusing Open Door Forum, HME News called Jim Bossenmeyer, director for the division of provider and supplier enrollment at CMS, for clarification on the Provider Enrollment, Chain and Ownership System (PECOS). For more information… Read More ›
