DME MAC Jurisdiction B News from CGS

CGS Medical Review Quarterly Reports by Policy

Analysis of claim denials for knee orthoses HCPCS codes L1833 and L1851 reviewed between April 1, 2021 and June 30, 2021 revealed a denial rate of 65.52%. Please click here for the top 10 reasons for claim denials.

Analysis of claim denials for AFO HCPCS codes L1902, L1906, L1971, L4396, and L4397 reviewed between April 1, 2021 and June 30, 2021 revealed a denial rate of 30.79%. Please click here for the top 10 reasons for claim denials.

Analysis of claim denials for lumbar sacral orthosis (LSO)HCPCS codes L0457, L0637, L0648, and L0650 reviewed between April 1, 2021 and June 30, 2021 revealed a denial rate of 38.37%. Please click here for the top 10 reasons for claim denials.

Analysis of claim denials for therapeutic shoes/inserts for diabetic persons HCPCS codes A5500 and A5512-A5514 reviewed between April 1, 2021 and June 30, 2021 revealed a denial rate of 88.35%Please click here for the top 10 reasons for claim denials.

 

Please click the links below for additional policy information.

Medicare Announces Rule to Protect Consumers from Surprise Medical Bills

Announcement is the first in a series of regulations aimed at shielding patients from increased financial hardships stemming from surprise medical bills

The Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans.

Please click on these links for more information   Consumer Protection  / What you need to know

No Healthcare organization can afford to waste money, time, or personnel on outdated systems.

No healthcare organization can afford to waste money, time, or personnel on outdated systems. In this issue of Becker’s Health CareReview, learn how our MotionMD®, VeriPro®, and OaraScore® software solutions can help improve efficiency, security, and benefit the industry in an interview with EVP of Healthcare Solutions Steve Ingel.  Please click here to read the entire article.  Becker’s Healthcare Article

DJO Global’s MotionMD® Software Solution Meets Industry Standards for Information Privacy and Security with HITRUST CSF Certification

SAN DIEGO–(BUSINESS WIRE)–DJO Global, Inc. (“DJO Global” or the “Company”), a leading global provider of medical technologies designed to get and keep people moving, today announced their MotionMD® software solution has received security certification from The Health Information Trust Alliance (HITRUST). The HITRUST CSF, a widely-adopted information privacy and security framework, helps support MotionMD’s compliance with certain healthcare standards by providing a secure and protected platform for sensitive and private healthcare patient information.

MotionMD underwent an in-depth review to obtain the HITRUST CSF Certification, which demonstrates that the software’s security controls are consistent with national and international security standards including ISO, NIST, PCI-DSS and HIPAA. The process normalizes security requirements and provides clarity and consistency, reducing the burden of compliance with the privacy and security regulations that apply to healthcare organizations.

We want our customers to feel safe when they provide sensitive healthcare information to our MotionMD platform,” said Terrence Weekes, DJO Global’s chief information security officer. “Since privacy and security are significant priorities for us, we continually strive to achieve the highest level of security for our systems. The HITRUST CSF Certification validates our efforts and provides an industry-recognized endorsement to our partners.”

MotionMD is an intuitive, web-based point-of-care solution designed to support claims management and inventory dispensing. This paperless software solution can help orthopedic clinics improve patient satisfaction, better manage billing compliance and streamline workflow by providing seamless interoperability with clinic records.

“I am proud of our team and the work they do each day to ensure patient health information is secure and protected within our network,” said Steve Ingel, president global bracing and supports. “Our industry leadership is further strengthened by our HITRUST CSF Certification and demonstrates we are a distinguished partner within the orthopedic device industry.”

About DJO Global

DJO Global is a leading global provider of medical technologies designed to get and keep people moving. The Company’s products address the continuum of patient care from injury prevention to rehabilitation after surgery, injury or from degenerative disease, enabling people to regain or maintain their natural motion. Its products are used by orthopaedic specialists, primary care physicians, pain management specialists, physical therapists, podiatrists, chiropractors, athletic trainers and other healthcare professionals. In addition, many of the Company’s medical devices and related accessories are used by athletes and patients for injury prevention and at-home physical therapy treatment. The Company’s product lines include rigid and soft orthopaedic bracing, hot and cold therapy, bone growth stimulators, vascular therapy systems and compression garments, therapeutic shoes and inserts, electrical stimulators used for pain management and physical therapy products. The Company’s surgical division offers a comprehensive suite of reconstructive joint products for the hip, knee and shoulder. DJO Global’s products are marketed under a portfolio of brands including Aircast®, Chattanooga, CMF™, Compex®, DonJoy®, ProCare®, DJO® Surgical, Dr. Comfort® and ExosTM. For additional information on the Company, please visit www.DJOglobal.com. DJO Global has extensive experience billing DME and is bringing this expertise to clients with MotionMD. For more information on MotionMD, visit www.djoglobal.com/motionmd.

Contacts

DJO Media Contact:
Kelly Gaffney
Corporate Communications
760.734.5603
Kelly.Gaffney@djoglobal.com
or
DJO Investor Contact:
David Smith
SVP, Treasurer and Investor Relations
760.734.3075
IR@djoglobal.com