Category: Medicare

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

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

PDAC has rescinded the requirements for product labeling as outlined in the article titled Product Labeling and Product Sample Requirements for Coding Verification that was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

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 click here for more information CODING GUIDELINES