Audits start to pile up

Dressings, orthotics, urological supplies, CGMs all under review
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Tuesday, September 15, 2020

WASHINGTON - CGS, the DME MAC for jurisdictions B and C, will be conducting complex post-pay reviews for surgical dressings and knee orthoses, according to AAHomecare.

CGS will be reviewing A6196 and A6212, and L1833 and L1851. The DME MAC is conducting the reviews due to data analysis that showed “significantly above expected amounts.”

Surgical dressings and knee orthoses also ranked No. 5 and No. 9, respectively, in total CERT improper payment rates. The reviews will include only claim dates prior to the public health emergency.

Urological supplies

CGS will also be conducting complex post-pay medical reviews on urological supplies, according to the van Halem Group.

A4351, A4352, A4353, A4355 and A4316 have been selected based on data analysis that revealed the allowed dollars for these codes have been “significantly above expected amounts.” Further analysis revealed they have also received multiple CERT errors.

Reviews will include only claim dates prior to the PHE.

CGMs and supplies                                                   

CMS has approved the RAC, Performant, to begin reviewing continuous glucose monitors for medical necessity requirements and CGM supplies for excessive units effective Sept. 8, according to the van Halem Group.

Performant will be reviewing K0554 and K0553.