New Prepayment Probe to Focus on High-Dollar DMEPOS

The Supreme Court met and released several more decisions this morning, but did not release the health care decision.  The court also announced Thursday would likely be the final day of the session, so the health care bill decision will likely come on Thursday around 10:00 AM EST.  A refresher of the case currently in front of the court and the potential effect on the O&P profession can be found here.  OPGA Government Relations will continue to follow the court’s decision and provide the most up-to-date information to OPGA members on Thursday morning.

In other news, the National Government Services DME MAC Jurisdiction B (Noridian) recently released information regarding a new prepayment probe focusing on “high-dollar” DMEPOS claims.  The probe is not product or code specific, rather cost specific, which analysts believe will likely focus on complex rehabilitation equipment, orthotics and prosthetics. The review will focus on ensuring medical necessity is properly documented for a claim prior to releasing the claim to be paid.  Providers will be notified of a prepayment review by receiving a letter sent to the address CMS has on file for the billing number requesting additional documentation.  Do not ignore these letters or you will not be paid. Providers are found to be in violation of Medicare Supplier Standard #28 if they fail to respond to a request for further documentation in a timely fashion; the length of time you have to respond will be detailed in your specific letter.  The most up-to-date LCD information regarding proper medical necessity documentation can be found HERE.  

The HHS Office of Inspector General (OIG) is accepting public comments on self-disclosure requirements of potential fraudulent activity, mainly suspected potential overpayments. According to the notice released last week, the public comments will inform policy discussions that “provides guidance on how to investigate this conduct, quantify damages and report the conduct to the Office of Inspector General (OIG) to resolve the provider’s liability exposure under OIG’s civil money penalty authorities”. Comments are being accepted until August 14, 2012 and can be accessed here.

This entry was posted in Orthotics and Prosthetics, Prosthetist, re provider and tagged , , , . Bookmark the permalink.

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