Monthly Archives: December 2012

Widespread Review of Spinal Orthoses Brings 90% Denial on L0631 and L0637 Claims

Posted on December 18, 2012 by ryanball1

Jurisdiction D DME MAC recently completed a widespread prepayment review of certain spinal orthoses, L0631 and L0637, due to an analysis compiled by CERT audit contractors.  The results are very troubling and will likely trigger more widespread reviews of the L codes … Continue reading →

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CMS: Partial Medicaid Expansions Not Eligible for Increased Matching Funds

Posted on December 11, 2012 by ryanball1

The Affordable Care Act mandates all states expand their Medicaid enrollment to 133% of the Federal Poverty Level (FPL), or risk losing all federal matching funds for their Medicaid program. However, in June the Supreme Court ruled the Medicaid expansion … Continue reading →

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Breaking: CMS Issues Final Rule on Medical Device Excise Tax O&P Status

Posted on December 5, 2012 by ryanball1

Earlier today, CMS published the final rule on the implementation of the medical device excise tax in the Federal Register. The medical device excise tax, a 2.3% tax levied on Class I, II and III medical devices, has been a … Continue reading →

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Lame Duck Session and Fiscal Cliff Update

Posted on December 5, 2012 by ryanball1

The President, congressional Republicans and Democrats have been negotiating in public for the past several weeks.  The President released his plan to avoid the fiscal cliff, calling for $1.6 trillion in new tax revenue (primarily from letting Bush tax cuts expire … Continue reading →

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