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
Tag: Durable Medical Equipment
Effective March 25, 2011: Implementation of Provider Screening and Risk Based Categories for Provider/Supplier Enrollment
It is the continuing goal of the Centers for Medicare & Medicaid Services (CMS) to reduce fraud, waste, and abuse through all available avenues. The Affordable Care Act requires CMS to determine the level of screening to be conducted during provider and supplier enrollment based on the level of risk posed to the Medicare system. With the enactment of the Affordable Care Act, we have the increased ability to focus our efforts on prevention, rather than simply acting after the fact. The use of risk categories and associated screening levels will help ensure that only legitimate providers and suppliers are enrolled in Medicare, Medicaid, and CHIP, and that only legitimate claims are paid.
Effective Friday, March 25, 2011, newly-enrolling and revalidating providers and suppliers will be placed in one of three screening categories – limited, moderate, or high. These categories represent the level of risk for fraud, waste, and abuse to the Medicare program for the particular category of provider/supplier, and determine the degree of screening to be performed by the Medicare Administrative Contractor (MAC) processing the enrollment application. For more information please click here: CMS Please refer to the regulation published to the Federal Register
MEDICARE ORDERING AND REFERRAL FILE
As stated in the CMS provider listserv messages that were sent last fall concerning CRs 6417 and 6421, CMS has made available in the Downloads section of this web site a file that contains the National Provider Identifier (NPI) and the name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is legally eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in PECOS). This is a .pdf file containing approximately 800,000 records.
A new file will be made available periodically that will replace the posted file; at any given time, only one file (the most recent) will be available. The file can be downloaded by users with technical expertise and further sorted or manipulated. It can also be used to search for a particular physician or non-physician practitioner by NPI or by name. Please note the following: (1) Records are in alphabetical order based on the surname of the physician or non-physician practitioner. (2) Name suffixes (e.g., Jr.), if they exist, are not displayed. (3) There are no “duplicates” in the file. Many physicians or non-physician practitioners share the same first and last name; their corresponding NPIs are the assurance of uniqueness. (4) Deceased physicians and non-physician practitioners are not included in the file.
Please click here for the source of this post and access to the Medicare Ordering and Referral File
Knee Orthoses—Prepayment Review Update
For more information, please click above on the title of this post, then click the link For additional information
The National Government Services Jurisdiction B Medical Review Department recently conducted a prepayment targeted medical review of Knee Orthoses. This is a widespread random selection of submitted claims based on a targeted service(s) from multiple suppliers which are reviewed for medical necessity.
Surety Bonds-Medicare Enrollment
For more information, please click above on the title of this post, then click the link For more information
On December 29, 2008, CMS announced regulations requiring suppliers of certain DMEPOS to post a surety bond as a condition of new or continued Medicare enrollment. The regulation states that beginning May 4, 2009:
- Suppliers seeking to enroll or changing the ownership of a DMEPOS supplier must submit a $50,000 surety bond for each assigned National Provider Identifier (NPI) for which the DMEPOS supplier is seeking to obtain Medicare billing privileges.
- Existing DMEPOS suppliers must submit to the National Supplier Clearinghouse (NSC) a $50,000 surety bond for each assigned NPI no later than October 2, 2009.
- A DMEPOS supplier enrolling a new practice location must submit to the NSC a new surety bond or an amendment or rider to the existing bond, showing the new practice location is covered by an additional base surety bond of $50,000.
Suppliers who have certain adverse legal actions imposed against them in the past may be required to post a higher bond amount. The final regulations permit the NSC to require DMEPOS suppliers to obtain a base surety bond of $50,000 and an elevated surety bond of $50,000 for each occurrence of an adverse legal action within ten years preceding enrollment, revalidation, or reenrollment in the Medicare program.
DME INFO 