Tag: Recovery Audit Contractor (RAC)
In brief: Regulatory update, e-prescribing report, Lincare acquisition
February 18, 2022HME News Staff
WASHINGTON – CMS on Feb. 10 published a change request notifying the DME Medicare Administrative Contractors of the agency’s new national coverage determination for home oxygen therapy.
CMS notes the following changes are effective for claims with dates of service starting Sept. 27, 2021:
expansion of oxygen coverage for acute and chronic conditions;
expansion of coverage for short and long-term need (when hypoxemia exhibited);
the ability of the...
Regulatory update: DME MACs notified, RACs limited
February 15, 2022HME News Staff
WASHINGTON – CMS on Feb. 10 published a change request notifying the DME Medicare Administrative Contractors of the agency’s new national coverage determination for home oxygen therapy.
CMS notes the following changes are effective for claims with dates of service starting Sept. 27, 2021:
expansion of oxygen coverage for acute and chronic conditions;
expansion of coverage for short and long-term need (when hypoxemia exhibited);
the ability of the MACs...
Audits start to pile up
September 15, 2020HME News Staff
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...
RAC notifies providers of reviews
August 21, 2020HME News Staff
WASHINGTON - Performant, Medicare's RAC, has notified providers by letter that, per authorization from CMS, it will resume certain medical review activities, according to the van Halem Group.
The notification says providers have an additional 30 days to submit discussion requests for review for result and initial findings letters dated Feb. 27, 2020, to March 27, 2020. It also advises providers to access the Provider Portal to review any claims pertaining to those dates.
Performant most...
RAC adds beds, manual wheelchairs to audits
February 7, 2020HME News Staff
WASHINGTON - The Recovery Audit Contractor (RAC) has received approval to audit hospital beds and manual wheelchairs, according to a bulletin from AAHomecare. The issue names are “Hospital Beds: Medical Necessity and Documentation Requirements” and “Manual Wheelchairs: Medical Necessity and Documentation Requirements.” These are both complex reviews and the RAC will be determining whether the items were reasonable and necessary based on the medical record. The RAC...
Audit round up: RACs cut checks, UPICs run roughshod
June 28, 2019Theresa Flaherty, Managing Editor
YARMOUTH, Maine - Nearly two years after Performant Recovery announced it would perform an underpayment review for Group 3 power wheelchair options, providers are receiving refund checks, says Andrea Stark.
Performant, the DMEPOS RAC, announced in May 2017 it would review wheelchair accessories, including seating systems, and seat and back cushions furnished in conjunction with codes K0848—K0864 for the six-month period of Jan. 1, 2016—June 30, 2016. The review was necessary because...
RAC to audit test strips
June 18, 2019HME News Staff
WASHINGTON - Performant, the national RAC for DME, received approval from CMS on June 14 to audit blood glucose test strips (A4253) nationwide.
“The quantity of glucose test strips that are covered depends upon the usual medical needs of the diabetic patient,” reads an announcement on the RAC's website. “Documentation will be reviewed to determine if the utilization guidelines for glucose test strips were met.”
The RAC will be reviewing claims that have a “claim...
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...
RAC targets pneumatic compression devices
January 29, 2019HME News Staff
ATLANTA - Performant Recovery, the national DMEPOS RAC, added pneumatic compression devices to its approved issues list on Jan. 23, the van Halem Group reports. Performant will perform complex reviews to determine if the pneumatic compression device is reasonable and necessary for the patient's condition based on the documentation in the medical record. Claims that do not meet the indications of coverage and/or medical necessity will be denied. The audit will cover E0651 and E0652 for claims...
Vents: RACs join the party
January 26, 2018Theresa Flaherty, Managing Editor
WASHINGTON - The national recovery audit contractor for HME has set its sights on ventilators, but that's no big surprise, industry stakeholders say.
The Medicare Administrative Contractors are already auditing vents, and the Office of Inspector General has included the product category in past work plans.
“I think it's a no-brainer for the RACs to say, 'Hey let's audit this, too,'” said Kim Brummett, vice president of regulatory affairs for AAHomecare.
Performant...