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
Author: DME INFO
Current Orthopedic and DME news and resources.
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
New Tools to Fight Fraud, Strengthen Federal Health Programs, and Protect Taxpayer Dollars
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 claims before they are paid to track fraud trends and flag suspect activity. New power to fight fraud, granted in the health reform law, will also help achieve the 2012 goal of cutting the rate of improper payment claims in the traditional Medicare program by half. Please click here for more details CMS Fights Fraud
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 Year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled. Please click here for entire press release
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
