Category: Customer Information
Results of Widespread Prepayment Review of Claims for Lumbar-Sacral Orthoses, HCPCS Codes L0631/L0637
The DME MAC Jurisdiction A has completed the widespread prepayment review of claims for Lumbar-Sacral Orthoses (HCPCS codes L0631 and L0637). These findings include claims processed primarily from March 2015 through May 2015. The review involved prepayment complex medical review of 1,384 claims submitted by 423 suppliers. Responses to the Additional Documentation Request (ADR) were not received for 582 (42%) of the claims. For the remaining 802 claims, 148 claims were allowed and 654 claims were denied resulting in a claim denial rate of 82%. The overall CDR was 81.8%. Please click here for entire report
CMS Launches Sunshine Website
The Sunshine Law (officially known as the National Physician Payment Transparency Program) creates greater transparency around the financial relationships of manufacturers, physicians, and teaching hospitals.
The Sunshine Law requires that the following information is reported annually to CMS:
- Applicable manufacturers of covered drugs, devices, biologicals, and medical supplies to report payments or other transfers of value they make to physicians and teaching hospitals to CMS.
- Applicable manufacturers and applicable group purchasing organizations (GPOs) to report to CMS certain ownership or investment interests held by physicians or their immediate family members.
- Applicable GPOs to report to CMS payments or other transfers of value made to physician owners or investors if they held ownership or an investment interest at any point during the reporting year.
CMS will collect this data, aggregate it, and publish it on a public website. Please click here for more information: SUNSHINE
AFFORDABLE CARE ACT “SUNSHINE RULE” INCREASES TRANSPARENCY IN HEALTH CARE
The Centers for Medicare & Medicaid Services (CMS) announced today a final rule that will increase public awareness of financial relationships between drug and device manufacturers and certain health care providers. Called the “National Physician Payment Transparency Program: Open Payments,” this is one of many steps in the Affordable Care Act designed to create greater transparency in the health care market.
“You should know when your doctor has a financial relationship with the companies that manufacture or supply the medicines or medical devices you may need,” said Peter Budetti, M.D. CMS deputy administrator for Program Integrity. “Disclosure of these relationships allows patients to have more informed discussions with their doctors.” Please click here to read the entire press release SUNSHINE
New Tools to Fight Fraud, Strengthen Medicare and Protect Taxpayer Dollars
The Affordable Care Act improves and expands consumer protections, strengthens Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), and reduces health care costs. One important way it achieves these goals is by improving government-wide efforts to fight fraud, waste and abuse. The new law contains some critical new tools to improve and enhance the Administration’s efforts to prevent and detect fraud, and crack down on individuals who attempt to defraud Medicare, Medicaid, and CHIP as well as private insurance. Please click here for more information: New Tools to Fight Fraud
DME INFO 