Tag: Claims
Trella Health ramps up claims dataset
September 25, 2023HME News Staff
ATLANTA – Trella Health, a provider of market intelligence and integrated customer relationship management (CRM) solutions, is expanding its dataset to provide its home medical equipment and infusion customers with deeper visibility into their markets through advanced metrics and analytics. “We’re acting on what our customers have been telling us,” said Pierre Menard, chief technology officer at Trella Health. “While Trella provides a unique and valuable view into HME...
CareCentrix addresses concerns during meeting
September 25, 2019HME News Staff
WASHINGTON - CareCentrix has begun a system-wide analysis to determine areas where it can improve its processes, and started working with insurance plans to improve the reconsideration process and timeliness of responses, AAHomecare reports. The developments were the result of a recent meeting between association and CareCentrix officials. “Suppliers and major payer groups have a shared responsibility to support patients, caregivers and clinicians with quality HME products and services,”...
Regulatory news: CMS revamps audits, lawmakers question CPAP bundling
August 18, 2017HME News Staff
WASHINGTON - Claims submitted by providers that have the highest claim error rates or billing practices that vary significantly from their peers will soon face increased scrutiny, CMS has announced.
As part of an expanding “Targeted Probe and Educate” program, the Medicare Administrative Contractors will identify these providers through data analysis.
“TPE claim selection is different from that of previous probe and educate programs,” the agency stated in an Aug. 14...
CMS revamps claims review process
August 16, 2017HME News Staff
WASHINGTON - Claims submitted by providers that have the highest claim error rates or billing practices that vary significantly from their peers will soon face increased scrutiny, CMS has announced.
As part of an expanding “Targeted Probe and Educate” program, the Medicare Administrative Contractors will identify these providers through data analysis.
“TPE claim selection is different from that of previous probe and educate programs,” the agency stated in an Aug. 14...
Billing systems get more sophisticate
April 24, 2017John Andrews
The term “billing system” is becoming archaic. The technology that once served as automated claims processing for HME providers has evolved into a virtual control center with multi-dimensional capabilities.
Now described with terms such as enterprise resource planning and integrated business management platforms, the billing systems of old have advanced to a point where they can serve all of an HME provider's automation needs, information technology specialists say.
“Providers...
QIC demo sets 'different tone'
May 13, 2016Tracy Orzel
Kansas City, Mo. - Able Care Health Equipment in Kansas City, Mo., was recently selected to take part in a new demo project that provides a more interactive process for resolving claims at Medicare's second level of appeals.
The demo, launched in January by C2C Innovative Solutions, Medicare's Qualified Independent Contractor or QIC, allows providers to speak with a reconsideration professional by phone to try and resolve their cases.
Jason Hood, CFO of Able Care Health Equipment, spoke...
CMS repairs web glitch
January 27, 2014HME News Staff
NASHVILLE, Tenn. - CMS has corrected an issue in the DME MAC claim system that had been affecting processing, CGS said in a Jan. 24 bulletin. Claims are now being processed using ordering/referring physician data from PECOS, according to the statement. Any claims incorrectly denied because of the problem will be reprocessed automatically, CGS said. In addition, the myCGS web portal and Jurisdiction C IVR are assessing the corrected ordering/referring physician file, according to the bulletin.
In brief: CMS reports glitch, OIG reports overpayments
January 17, 2014HME News Staff
NASHVILLE, Tenn. - A problem with ordering/referring physician data in the DME MAC claim system is affecting processing, as well as the data available in the myCGS web portal and the Jurisdiction C IVR, according to a bulletin from CGS. CMS and DME MAC system maintenance contractors are researching the issue. CGS says it will provide more information when it becomes available. CMS on Jan. 6 started denying claims with the names of physicians who are not enrolled in PECOS.
Medicare overpays...
CMS reports PECOS-related glitch
January 16, 2014HME News Staff
NASHVILLE, Tenn. - A problem with ordering/referring physician data in the DME MAC claim system is affecting processing, as well as the data available in the myCGS web portal and the Jurisdiction C IVR, according to a bulletin from CGS. CMS and DME MAC system maintenance contractors are researching the issue. CGS says it will provide more information when it becomes available. CMS on Jan. 6 started denying claims with the names of physicians who are not enrolled in PECOS.
Providers targeted for certain claims
July 22, 2010Theresa Flaherty, Managing Editor
ALEXANDRIA, Va. - Medicare is demanding repayment for diabetes and other Part B supplies that it says should have been billed to other payers, but industry stakeholders say the products were dispensed in "good faith."
"We are worried this is just getting started and it's going to get bigger," said Susan Janeczko, director of long term, regulatory and policy affairs, for the National Community Pharmacists Association (NCPA). "They are going back to 2006, then they could work their way up."
The issue:...