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Brown & Fortunato

Legal: Don’t violate payer contracts

Q. I am not in network with a certain third-party payer. Can I enter into a subcontract agreement with another DME supplier that is in network with that payer?

A.  This is probably not a good idea.

Legal: Mind the threshold

Q. Can I pay a lead generation company for leads?

A.  Yes, but the appropriate payment terms will depend on the nature of the leads.

Single-source contract ‘promotes favoritism’


AMARILLO, Texas – HME providers in Texas have solid ground to stand on when it comes to their criticism of a new Medicaid contract that makes Medline a single-source provider of 244 DME supplies, says an industry attorney.

Overpayments: Create culture of compliance

Q. What is the best remedy for overpayment problems?

A. In previous columns, I discussed how the 60-day overpayment rule presents a myriad of problems and questions that are sometimes difficult for an HME supplier to identify and address.

Overpayments: Follow protocol

Q. How do I return an overpayment to the government?

A. Typically, suppliers report and return overpayments to the DME MAC of jurisdiction. Each DME MAC has a standard overpayment refund form. The supplier simply provides information and submits a refund check.

Overpayments: Extrapolate overpayments

Q. How deeply do I need to investigate potential problems?

A. My last column explained CMS’s final rule clarifying the 60-day rule, which allows a supplier up to six months to quantify an overpayment once it’s identified.

Overpayments: Exercise reasonable diligence

Q. What do I need to know about the 60-day rule?

A. The Affordable Care Act requires a person who has received an overpayment to report and return the overpayment to the government.  

Medicare tweaks documentation process


WASHINGTON – Three recent changes to the Program Integrity Manual could give providers some relief from common documentation woes, say industry attorneys.

At the top of the list: a clarification of CMS’s policy on templates.

New season of HME Voice set to kick off


ATLANTA – The second season of HME Voice is slated to begin May 16, according to a Medtrade press release.