Tag Archives: CERT

Jurisdiction D External Breast Prosthesis Prepayment Review Findings

Earlier this week Jurisdiction D DME MAC Medical Review Department announced their findings of a widespread prepayment review of L8030. This prepayment review probe was created after the review of a Comprehensive Error Rate Testing (CERT) analysis. Much like the findings … Continue reading

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OPGA Launches Speak4OandP, Calls for Independent Practitioner Action

Are you tired of being audited on seemingly all prosthetic claims for Medicare beneficiaries? Now is the time to stand up for independent orthotic and prosthetic practitioners and facilities. Orthotic and Prosthetic Group of America (OPGA) recently launched Speak4Oandp.com, a … Continue reading

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CERT Prepayment Review on High Cost Claims Shows 89% Denial Rate

NGS in Jurisdiction B recently completed an analysis of prepayment review claims focused on medical necessity in the third quarter of 2012. The claims selected were based on a selection of high dollar claims and targeted services from multiple suppliers. The review included claims for orthotics … Continue reading

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Oversight of Medicare Audit Contractors, Surety Bond Comments

Lost in the media attention surrounding the Supreme Court ruling on the Affordable Care Act was the fact that key members of both parties, including: Senators Hatch, Baucus, Coburn, Carper, Grassley and Congressmen Waxman, Stearns, Boustany, Lewis and DeGette, recently sent a letter … Continue reading

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