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 298,097 in 2010. At the same time, Medicare funds recovered that were attributable to the projects were $19,283 in 2011. Total savings to Medicare, Medicaid, beneficiaries, and others were $32,941. Additionally, cost avoidance on behalf of the Medicare program, the Medicaid program, beneficiaries, and others, totaled $247,850. One of the projects, however, reported referring two large-dollar cases to a Medicare contractor. In one of these cases, the Medicare contractor is seeking to recover $2.9 million in overpayments from a provider who was identified by the project.  Please click here for more information:  Senior Medicare Patrol

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) analysis and previous review results.  In order to evaluate compliance with Medicare coverage and coding rules, all suppliers billing Jurisdiction D for HCPCS codes listed above are subject to this review. Suppliers of the selected claims will receive an Additional Documentation Request (ADR) letter asking for specific information to determine if the item billed complies with the existing reasonable and necessary criteria. Failure to supply the requested information within 45 days of the date on the letter will result in the claim being denied. The ADR letter will provide instruction for submitting documentation.  Please click here for more information:  Noridian Notification

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 requirement in your region, please click the appropriate link. REGION A  REGION B  REGION C  REGION D

Effective July 1, 2012: Local Coverage Determination (LCD) for Knee Orthoses (L27263)

Medicare Approves An Addition Code for Custom Knee Bracing.

For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements. For the items addressed in this local coverage determination, the criteria for “reasonable and necessary”, based on Social Security Act §1862(a)(1)(A) provisions, are defined by the following indications and limitations of coverage and/or medical necessity.  Please click here for the Knee Orthoses LCD