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.
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
We recently passed the one year mark of the roll-out of CMS’s changes to HCPCS coding for orthotics. If you have been tracking this issue, you know that CMS made significant changes to the coding structure by establishing two separate categories of HCPCS orthotic codes: Off-the-Shelf (OTS) and Custom Fitted (CST). We thought this would be a good time to review these changes and their implications.
As a reminder, the CMS definitions for OTS and CST orthotics are included below:
OTS Orthotics: Require minimal self-adjustment for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit the beneficiary. Minimal self-adjustment is an adjustment that the beneficiary, caretaker for the beneficiary, or a supplier of the device can perform and that does not require the services of a certified orthotist or an individual who has specialized training.
Custom Fitted Orthotics: Require fitting by someone with specialized education, training, and experience in fitting and certification and/or licensing.
If you are a DJO customer you have probably noticed that DJO now lists two recommended HCPCS codes on applicable product labels: one code for OTS and another for CST. Each customer should carefully review the CMS requirements to determine which is the most appropriate code to bill. Although, for now, the Medicare reimbursement for an OTS code is the same as a CST code, you must still meet the Medicare CST requirements when you bill a CST code. Failure to do so could subject you to Medicare repayments and even fines in the face of a Medicare audit.
For commercial payors, this change has created quite a bit of confusion. While most commercial payors are recognizing the new codes, there are still some that do not. We recommend that you check with your commercial payors to see how they are addressing the new coding structure. Depending on what you find out, you may want to check your payor contracts to determine if updates are indicated. For example, are the OTS codes listed and, if so, is there an associated fee schedule? And don’t forget to audit your payments to ensure you are getting paid appropriately by both Medicare and private payors.
If you would like more information or have questions about these changes please feel free to reach out to your local DJO representative.
Jurisdiction D DME MAC Medical Review Department completed a widespread prepayment probe review of HCPCS codes L0631 and L0637. This review was initiated based on reason for review by CERT analysis.
The L0631 review involved 101 claims of which 96 were denied. This resulted in an overall error rate of 96%.
The L0637 review involved 100 claims of which 80 were denied. This resulted in an overall error rate of 80%.
Primary documentation errors that resulted in denial of claims
- 24% of L0631 claims received a denial as Criteria 1 not met.
- 14% of L0637 claims received a denial as Criteria 1 not met.
The beneficiary’s medical records did not indicate the LSO order as reasonable and medically necessary as described in LCD 11459.
A lumbar-sacral orthosis is covered when it is ordered for one of the following indications:
- To reduce pain by restricting mobility of the trunk; or
- To facilitate healing following an injury to the spine or related soft tissues; or
- To facilitate healing following a surgical procedure on the spine or related soft tissue; or
- To otherwise support weak spinal muscles and/or a deformed spine.
- 23% of L0631 claims received a denial as documentation does not support medical necessity for the item requested.
- 13% of L0637 claims received a denial as documentation does not support medical necessity for the item requested.
The beneficiary’s medical records did not justify the LSO as medically reasonable and necessary.
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.
- Beneficiary’s medical record submitted does not have sufficient objective documentation to validate beneficiary use of a LSO as reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the function of a malformed body member.
- According to the supplier manual the provision of an identical or nearly identical item may be replaced when a new physician order and/or new CMN, when required, is needed to reaffirm the medical necessity of the item. The useful lifetime of a spinal orthosis is no less than 5 years. Medical record documentation must validate the need for a new or replaced spinal orthosis.
- 14% of L0637 claims received a denial as no proof of delivery submitted.
- 7% of L0631 claims received a denial as invalid proof of delivery.
L0637 – No proof of delivery submitted.
Proof of delivery (POD) is a Supplier Standard and DMEPOS suppliers are required to maintain POD documentation in their files. For medical review purposes, POD serves to assist in determining correct coding and billing information for claims submitted for Medicare reimbursement. Regardless of the method of delivery, the contractor must be able to determine from delivery documentation that the supplier properly coded the item(s) submitted for Medicare reimbursement and that the item(s) are intended for, and received by, a specific Medicare beneficiary.
L0631 – Requirements for proof of delivery.
Delivery Directly to Beneficiary
POD record must include:
- Beneficiary’s name
- Delivery address
- Sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description)
- Quantity delivered
- Date delivered
- Beneficiary (or designee) signature and date of signature.
The date of signature on the delivery slip must be the date that the DMEPOS item was received by the beneficiary or designee. In instances where the supplies are delivered directly by the supplier, the date the beneficiary received the DMEPOS supply must be the date of service on the claim.
If a supplier utilizes a shipping service or mail order, suppliers must use the shipping date as the date of service on the claim.
- 12% of L0631 claims received a denial as no documentation received.
A large number of suppliers failed to respond to our request for records. Suppliers are in violation of Supplier Standard #28 when, upon request, they fail to provide requested documentation to a Medicare contractor. Medicare regulations (42 C.F.R §424.516[f]) stipulate that a supplier is required to maintain documentation for seven years from the date of service and, upon the request of CMS or a Medicare contractor, provide access to that documentation. Therefore, the consequences of failure to provide records may not only be a claim denial but also referral to the NSC.
- 12% of L0637 claims received a denial as billing requirements not met.
Part A Covered SNF or Hospital Stay
- Payment for spinal orthosis is included in payment to hospital or SNF if:
- The orthosis is provided to a patient prior to an inpatient hospital admission or Part A covered SNF stay; and
- Medical necessity for the orthosis begins during the hospital or SNF stay (e.g., after spinal surgery).
- Orthosis is provided to a patient during an inpatient hospital or Part A covered SNF stay prior to the day of discharge; and
- Patient uses the item for medically necessary inpatient treatment or rehabilitation.
DME MAC submitted claim
- Payment for spinal orthosis delivered to patient in hospital or Part A covered SNF stay is eligible for coverage by DME MAC if:
- The orthosis is medically necessary for a patient after discharge from a hospital or Part A covered SNF stay; and
- The orthosis is provided to the patient within two days prior to discharge home; and
- The orthosis is not needed for inpatient treatment or rehabilitation, but is left in the room for the patient to take home.
Based on high error rate, Noridian Administration Services will close this probe review and begin a widespread targeted review on HCPCS codes L0631 and L0637.