Tag: CGS
CGS launches review of No. 1 product category for CERT errors
March 22, 2021HME News Staff
NASHVILLE, Tenn. – CGS will be conducting complex post-pay, service-specific medical review of lower limb prostheses, L5700 and L5701, the contractor announced on March 19. “This review will be conducted because data analysis revealed that Jurisdiction C’s allowed dollars for L5700 and L5701 were significantly above expected amounts,” CGS stated. “Additionally, the orthotics policy group ranked No. 1 in total comprehensive error rate testing (CERT) errors.”...
CGS adds ostomy supplies, diabetic shoes to reviews
September 23, 2020HME News Staff
NASHVILLE, Tenn. - CGS has announced two more widespread post-pay, service-specific reviews for ostomy supplies and therapeutic shoes/inserts. For ostomy supplies, the codes affected are A4431, A4434, A5081, A5122. CGS says data analysis showed Jurisdiction C's allowed dollars for these codes were significantly above expected amounts. Additionally, these codes were consistently ranked in the top 20 for CERT errors. For therapeutic shoes/inserts, the codes affected are A5500 and A5512 through A5514....
Regulatory: Performant, CGS
May 23, 2019HME News Staff
WASHINGTON - Performant Recovery, the National DMEPOS RAC Contractor, has added upper limb orthoses to its approved issues list. Performant will review claims for upper limb orthoses with dates of service within five years of the date of service of a previously paid upper limb orthoses for the same beneficiary. HCPCS codes identified as same, for the same anatomical site, will be denied as the reasonable useful lifetime requirement has not been met� The Jurisdiction B and C councils met recently...
It's a bumpy start for prior authorizations
March 10, 2017Liz Beaulieu, Editor
WASHINGTON - CGS and Noridian have begun accepting prior authorization requests for K0856 and K0861, but complex rehab providers say they still don't have all the information they need to comply with the program.The contractors on March 6 began accepting requests for dates of delivery on or after March 20.“We're as prepared as we can be, with all the unanswered questions,” said Doug Westerdahl, president and CEO of Rochester, N.Y.-based Monroe Wheelchair, who, because of the uncertainty,...
DME MAC offers new online tool
December 1, 2016HME News Staff
NASHVILLE - CGS Administrators, the Jurisdiction B DME MAC, has launched Mr. Wizard, an online tool that provides detailed information on claims under review and the status of additional documentation requests. Providers simply enter their 14-digit claim control number to receive information on type of denial received and detailed explanation; provider NPI; date of service, code billed, and links to education and resources for particular denials.
CGS changes offset request process
July 26, 2016HME News Staff
NASHVILLE, Tenn. - CGS Administrators, the Jurisdiction B MAC, will no longer accept offset requests at the time of claim re-openings and adjustments, it said in a July 25 bulletin. Starting Aug. 1,suppliers who wish to have an overpayment withheld from future payments must wait for a demand letter. Upon receipt of the demand letter, the supplier may submit a request for immediate offset with, at minimum, a copy of the first page of the demand letter. Suppliers will have the option to submit a request...
CGS readies transition
March 30, 2016HME News Staff
NASHVILLE - CGS Administrators will take over the Jurisdiction B DME MAC contract July 5. The myCGS portal registration window for suppliers will open three weeks prior, and the process is expected to be a simplified, express registration to ease the transition, the agency said during a recent call. Jurisdiction B suppliers will receive a written invitation to pre-register. Any unfinished claims processing, appeals and other work will be officially transitioned from the previous contractor, National...
Here come the 'Super MACs'
January 29, 2016Liz Beaulieu, Editor
YARMOUTH, Maine - Industry stakeholders are weighing the recent shake up in the DME MACs.
For the first time ever, there will be two contractors handling claims processing for all four jurisdictions: CGS Administrators and Noridian Healthcare Solutions.
“This is definitely a big change,” said Wayne van Halem, president of The van Halem Group. “The four jurisdictions have been around since 1993 and there have always been four unique companies doing it. (CGS and Noridian) have...
In brief: CGS gets contract, VGM Insurance gives away thousands
January 15, 2016HME News Staff
NASHVILLE - CMS has awarded CGS Administrators a $78 million contract for DMEPOS claims in Jurisdiction B, according to a press release.
The contract represents approximately 20.7% of the national DMEPOS workload and covers claims by more than 6.8 million beneficiaries and 18,000 DME suppliers in Kentucky, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.
Nationally, CGS will now administer about 60% of Medicare DME claims.
CGS, which has been headquartered here since 1966 and...
CGS gains lion's share of DME workload
January 13, 2016HME News Staff
NASHVILLE - CMS has awarded CGS Administrators a $78 million contract for DMEPOS claims in Jurisdiction B, according to a press release.
The contract represents approximately 20.7% of the national DMEPOS workload and covers claims by more than 6.8 million beneficiaries and 18,000 DME suppliers in Kentucky, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.
Nationally, CGS will now administer about 60% of Medicare DME claims.
CGS, which has been headquartered here since 1966 and...