Tag: Jurisdiction B
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...
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...
Jurisdiction B reviews for power wheelchairs and catheters
December 5, 2014HME News Staff
INDIANAPOLIS -A claim review of power wheelchair-related options and accessories (K0820-K0829) from July 1, 2014, to Sept. 30, 2014, showed a denial rate of 81%. In the previous quarter, the rate was 84%. The most common reasons for denial:The face-to-face examination did not support why a manual wheelchair or a power operated vehicle wouldn't meet the beneficiary's mobility needs in the home; face-to-face examination did not support the beneficiary's mobility limitation…Also under claim review...
Prepay review shows substantial error rate
October 18, 2013HME News Staff
BALTIMORE - National Government Services, the Jurisdiction B DME MAC, is conducting a widespread prepay review of power wheelchairs without power seating options. The DME MAC processed 636 claims between July 1, 2013 and Sept. 1, 2013, and said 572 claims needed more documentation, according to a recent bulletin. Partial and full denials of those claims resulted in a 77% error rate. Denials were most common when documentation did not prove a manual wheelchair was unsuitable, did not demonstrate why...
Review finds 80% error rate for power wheelchairs
February 28, 2013HME News Staff
WASHINGTON - A prepayment review of power wheelchair claims processed in Jurisdiction B resulted in an 80% error rate, according to National Government Services (NSG), the DME MAC there. Of 1,022 claims processed from Oct. 1 2012�-Dec. 31, 2012, 122 were paid in full, while the remaining claims were completely or partially denied, according to the review. The most common reasons for denials were: Local Coverage Determination (LCD) criteria not met; face-to-face examination with a physician not...
Review finds 85.6% error rate for intermittent caths
February 28, 2013HME News Staff
WASHINGTON - A prepayment review of intermittent catheterization kits processed in Jurisdiction B resulted in an 85.6% error rate, according to National Government Services (NGS), the DME MAC there. Of 257 claims processed from Sept. 1-Dec. 31, 2012, 220 were denied, according to the review. The most frequent denial—“failure to meet one or more of the required coverage criteria”—accounted for 37% of denied claims. Sixty-one of the claims were denied because the requested documentation...