Tag: National Government Services (NGS)
Performant ready to roll
March 10, 2017HME News Staff
LIVERMORE, Calif. - Performant Recovery, the new national recovery audit contractor for DMEPOS and home health/hospice, announced March 8 that it has officially received approval from CMS to begin audit activity. The RAC in February posted seven new reviews on its workload page: complex medical necessity chest wall oscillation devices; complex medical necessity tracheotomy suction catheters, suction pumps, catheters and other related supplies and equipment; automated nebulizers not in accordance...
SMRC cuts providers some slack
December 9, 2016HME News Staff
WASHINGTON - SMRC contractors will give providers more time to respond to results letters, AAHomecare reported this week. The association had notified CMS that providers were being inundated with letters, and reviewing them and gathering supporting documents has been an overwhelming process. If providers need more time, they can send a written request to the SMRC for a discussion and education session within 30 days of the date of the final results letter, AAHomecare says. In their requests, providers...
Noridian publishes review results
July 7, 2015HME News Staff
FARGO, N.D. - Noridian Healthcare Solutions, the Jurisdiction D DME MAC, has published the results of prepayment reviews for a number of products. Oxygen (E1390) had a potential improper payment rate of 31% from March 2015 through May 2015. Group 2 pressure reducing support surfaces (E0277) had a potential improper payment rate of 62% from February 2015 though May 2015, while Group 1 pressure reducing support surfaces (E0181 and E0185) had improper rates of 52% and 63%, respectively, during that...
DME MAC launches manual wheelchair review
December 24, 2014Tracy Orzel
INDIANAPOLIS - So far, few providers in Jurisdiction B seem to be affected by a recent prepayment review for manual wheelchair bases, including adult tilt-in-space models (E1161).
“We don't have a lot of people billing E1161 in Region B since they changed it to a rental, so I don't think we're doing as many as we used to,” said billing consultant Sylvia Toscano, owner of Professional Medical Administrators. “It's possible, but I haven't seen it yet.”
The...
In brief: Fingerprint checks under way, HME companies make Inc. list
August 22, 2014HME News Staff
WASHINGTON - CMS began requiring fingerprint-based background checks for certain providers on Aug. 6, according to an MLN Matters article. The checks will first impact individuals with a 5% or greater ownership interest in a provider that falls into the high-risk category and is currently enrolled in Medicare or has submitted an initial enrollment application. The checks will be implemented in phases—not all providers in the high-risk category will be part of the first phase. Providers will...
RACs are back
August 8, 2014Liz Beaulieu, Editor
WASHINGTON - CMS announced last week that the recovery audit contractors (RACs) will restart some of their reviews, but industry stakeholders don't expect any curveballs.
Due to delays in awarding new contracts, the agency is giving the RACs the green light to get back to work on automated reviews and, on a limited basis, complex reviews.
“It doesn't sound like they're authorizing new audits, just reactivating the audits that they previously allowed,” said Andrea Stark,...
Certain RAC reviews to resume
August 6, 2014HME News Staff
WASHINGTON - CMS has announced that the current recovery audit contractors (RACs) will restart some of their reviews.
The RACs have been on hiatus from sending post-payment additional documentation requests (ADRs) since February, as part of the agency's transition to new RACs.
But, apparently, that transition is taking longer than CMS anticipated.
“Due to the continued delay in awarding new recovery auditor contracts, CMS is initiating contract modifications to the current recovery...
Review finds 70% error rate for VEDs
July 3, 2014HME News Staff
INDIANAPOLIS - In a first quarter 2014 widespread payment review of vacuum erection devices (VEDs), National Government Services examined 67 claims and denied 47, for an error rate of 70%, according to a release. The most common reasons for denial were: documentation that did not support diagnosis of impotence or erectile dysfunction; no medical records submitted; no documentation to support diagnosis of impotence or erectile dysfunction to allow coverage for the device; the proof of delivery record...
Prepayment review focuses on CPAP
May 22, 2014HME News Staff
INDIANAPOLIS - National Government Services, the Jurisdiction B DME MAC, plans to target CPAP devices for a widespread prepayment medical review, it announced in a message yesterday. Providers randomly selected for review will receive an additional development request asking for a detailed written order for the CPAP device and any accessory billed on the same claim; medical records documenting a face-to-face clinical evaluation prior to the sleep test detailing symptoms of sleep disorder, their duration,...
Error rate for glucose test strips tops out
May 15, 2014HME News Staff
INDIANAPOLIS - A prepayment review of glucose test strips resulted in a claim error rate of 99.2%, according to National Government Services. The Jurisdiction B DME MAC reviewed 8,758 claims filed between Jan. 1 and March 31. The top four reasons for denial: lack of medical necessity, documentation not returned within the requested time frame, billing more than the standard allowed quantity, and incorrect modifier submitted. Claims denied due to lack of medically necessary were: missing progress...