Tag: SMRC
SMRC audits orthopedic footwear
January 18, 2022HME News Staff
WASHINGTON – Noridian Healthcare Solutions, the Supplemental Medical Review Contractor for CMS, is conducting post-payment reviews for orthopedic footwear claims from Jan. 1, 2019, through Dec. 31, 2019. Orthopedic footwear is covered under the “leg, arm, back and neck braces, and artificial legs, arms and eyes” benefit. Coverage is provided when coverage, coding and documentation requirements are met. The reviews will include base and accessory codes. Noridian noted that this service...
SMRC reviews claims for surgical dressings
December 7, 2021HME News Staff
WASHINGTON – Noridian Healthcare Solutions, the Supplemental Medical Review Contractor for CMS, is conducting post-payment reviews of claims for surgical dressings billed on dates of service from Jan. 1, 2019, through Dec. 31, 2019. Surgical dressings are ranked in the top four categories with the highest improper payment rate at 62.8%, according to the 2019 Comprehensive Error Rate Testing Improper Payment Report. Medicare provides reimbursement for surgical dressings under the DMEPOS benefit,...
Depending on the contractor, audits are very much up and running
September 4, 2020Liz Beaulieu, Editor
COLUMBIA, S.C. - Audits have started to pop up in a number of places, including more recently, from the SMRC, says Andrea Stark. “I haven't seen any posts to the SMRC website announcing new audits, but I'm starting to hear the initial murmurings from suppliers they are receiving audit requests from the SMRC that may involve vents or oxygen - indicating a respiratory related review,” said Stark, a reimbursement consultant with MiraVista. “But they're non-public audit requests so...
In brief: US joins lawsuit against Arriva, SMRC targets PAP supplies
February 22, 2019HME News Staff
NASHVILLE, Tenn. - The U.S. Justice Department has joined in a lawsuit that alleges Arriva Medical offered Medicare beneficiaries “free upgrades” of glucometers.The lawsuit, filed under the False Claims Act, also alleges that Arriva and its parent company, Alere, submitted false claims for medically unnecessary glucometers, and paid kickbacks to beneficiaries in the form of free glucometers and co-pay waivers.Additionally, it alleges Arriva made no meaningful effort to collect co-pays...
SMRC adds PAP supplies to to-do list
February 21, 2019HME News Staff
WASHINGTON - Noridian Healthcare Solutions, the Supplemental Medical Review Contractor, has added PAP supplies to its review list. The audit is a post-payment review of claims for dates of service from Jan. 1, 2017, through Dec. 31, 2017, according to a blog from the van Halem Group. The Office of Inspector General previously found that Medicare allowed replacement of PAP supplies more frequently than was reasonable and necessary; and that DME suppliers often did not have the required documentation....
SMRC: Noridian is in, StrategicHealthSolutions is out
May 11, 2018Liz Beaulieu, Editor
FARGO, N.D. - Noridian Healthcare Solutions has taken over yet another CMS contract.The company, which is already the Medicare Administrative Contractor for jurisdictions A and D, and the Pricing Data Analysis and Coding contractor, among other things, has been awarded a $227 million contract to be the new Supplemental Medical Review Contractor.“Noridian has extensive DME experience in the field, so this is definitely in their wheelhouse,” said Andrea Stark, a reimbursement consultant...
In brief: Noridian named new SMRC contractor, Bachenheimer opens DC office for Brown & Fortunato
March 23, 2018HME News Staff
FARGO, N.D. - Noridian Healthcare Solutions has been awarded a $227 million Supplemental Medical Review Contractor (SMRC) contract by CMS. The primary role of the SMRC is to conduct nationwide medical review of Part A, Part B and DME providers as directed by CMS. Its responsibility is to review medical records and related documentation to ensure that claims are processed in accordance with CMS guidelines. The SMRC contract was previously held by StrategicHealthSolutions. To support the new contract,...
Noridian named new SMRC contractor
March 23, 2018HME News Staff
FARGO, N.D. - Noridian Healthcare Solutions has been awarded a $227 million Supplemental Medical Review Contractor (SMRC) contract by CMS. The primary role of the SMRC is to conduct nationwide medical review of Part A, Part B and DME providers as directed by CMS. Its responsibility is to review medical records and related documentation to ensure that claims are processed in accordance with CMS guidelines. The SMRC contract was previously held by StrategicHealthSolutions. To support the new contract,...
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...
Regulatory review: Suspensions, overpayments and exemptions
April 15, 2016Liz Beaulieu, Editor
WASHINGTON - From a regulatory perspective, the first several months of 2016 have brought pain, and a little bit of relief, to HME providers.
Among the pain points, says Wayne van Halem, is the new level of aggressiveness in the actions taken by the ZPICs. The contractors are handing out payment suspensions where, previously, they may have handed out overpayment demands, he says.
“Some of the reasons for suspensions are ridiculous,” said van Halem, president of The van Halem Group....