Category Archives: re provider

UPDATE: National DMEPOS RAC on hold after protest filed by Connelly competitor

Posted on January 15, 2015 by

Earlier this year, CMS released information about the new national recovery audit contractor (RAC) that will take the place of the four regional RAC’s currently auditing DMEPOS claims. Prior to this release, CMS announced it had selected Connelly LLC, currently the … Continue reading →

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AOPA backed audit lawsuit dismissed by District Court

Posted on August 6, 2014 by

The United States District Court of the District of Columbia recently dismissed a case brought by the American Orthotic and Prosthetic Association (AOPA) against Former Secretary of the Department of Health and Human Services Kathleen Sebellius. The suit focused on the authority of … Continue reading →

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CMS Informs Congress of intention to re-start portions of RAC program

Posted on August 5, 2014 by

From HealthDataManagement.com : The Centers for Medicare and Medicaid Services is restarting the controversial Recovery Audit Contractor Program—in a limited fashion—in August. CMS sent a communication on August 4 to congressional health staff members from Lauren Aronson, Director of the … Continue reading →

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Region D Scrutinizing K3 Feet

Posted on July 14, 2014 by

From time to time I like to present additional resources for OPGA members to review. The following post is from Ossur’s R&R blog and authored by David McGill, one of the leading audit experts in the O&P profession. The full post … Continue reading →

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Medicare Contractors looking for O&P supplier violations on posted business hours and physical facility standards

Posted on June 25, 2014 by

BE ON THE LOOK OUT FOR SITE VISITS BY MEDICARE CONTRACTORS! Wanted to pass along this article to OPGA membership; recently OPGA was contacted by several members who have had site visits from CMS contractors looking to verify that the … Continue reading →

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House Subcommittee Focuses on RAC’s in hearing, Duckworth stands up for small providers

Posted on May 20, 2014 by

Two major subcommittee meetings were held in the House of Representatives today on Medicare waste, fraud and abuse. One of the issues hightlighted in both hearings was the conduct of RAC auditors and the impact they are having on providers … Continue reading →

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Michigan BCBS adds certification requirement to bill O&P

Posted on May 1, 2014 by

Blue Cross Blue Shield of Michigan recently announced their plan to reject DMEPOS claims submitted for orthotics and prosthetics if the submitting provider has not provided certifying documentation proving they are certified to provide orthotics and prosthetics. Providers will be required to … Continue reading →

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House Subcommittee to hold hearing on Medicare fraud policies, RAC audits key topic

Posted on April 24, 2014 by

House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) announced yesterday that the Subcommittee on Health will hold a hearing on Medicare waste, fraud, and abuse, with a focus on the policies that address these problems.  Chairman Brady recently … Continue reading →

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CMS begins rollout of fingerprint analysis for new DMEPOS providers

Posted on April 17, 2014 by

CMS recently released guidance on the rollout of their new fingerprint background check requirement for certain DMEPOS providers. It has been more than three years since CMS released their final rule on developing a fingerprint background check process for new DMEPOS and home health … Continue reading →

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OTS Orthotics Defined… AGAIN!

Posted on March 28, 2014 by

When CMS released the 2014 HCPCS update codes late last year, they also provided guidance on how they would define “off the shelf” orthotics, for the purpose of identifying what type of provider could provide certain noncustomized devices to beneficiaries. After debate, CMS recalled … Continue reading →

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