The Centers for Medicare & Medicaid Services (“CMS”) announced in April of this year that it is adding 12 new HCPCS codes to the Required Prior Authorization List of DMEPOS items that require prior authorization as a condition of payment. Prior authorization for Pressure Reducing Support Surfaces will be implemented nationwide in October.
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Providers, suppliers and their billing staff need to be aware of the following recent changes to the Medicare program. A recent report from the New Jersey Office of the State Comptroller indicates an expansion of the efforts of its Medicaid Fraud Division (MFD) to investigate fraud, waste and abuse in the New Jersey Medicaid Program. The report also highlights MFD’s expanded effort to exclude providers from the Medicaid Program. The Centers for Medicare & Medicaid Services (CMS) has issued number of recent updates to the Medicare program which impact various providers and suppliers. Every year the Office of the Inspector General (OIG) issues a workplan that identifies the agency’s planned audit activities for the upcoming year. The workplan offers valuable information for healthcare entities by providing them with an opportunity to conduct appropriate risk assessments, and, where indicated, to modify the entity’s compliance program. On August 6, 2014, the Centers for Medicare and Medicaid Services (CMS) began implementing a new fingerprint-based background check requirement for individuals with 5% or greater ownership interest in providers and suppliers that fall into a high-risk category and are either currently enrolled or have pending enrollment in Medicare. This screening process will be conducted in phases and not all entities in the high-risk screening category will be subject to the first phase. The Centers for Medicare & Medicaid Services (CMS) announced that it will begin implementing the fingerprint-based background checks for providers and suppliers in certain risk categories. National Government Services Durable Medical Equipment Medicare Medical Review Department (NGS) has recently published the results of its third quarter prepayment medical review of high-error audit claim. In total, NGS reports, more than half of claims were denied, results in a 65 percent of claims error rate for failing to the required coverage criteria and documentation. Round 2 competitive bidding program (Program) went into effect as of July 1, 2013 in 91 Metropolitan Statistical Areas (MSAs). At the same time, Medicare began the national mail-order program for diabetic supplies. Below we discuss some of the features of the Program and what this may mean for DMEPOS suppliers and those healthcare providers who refer patients for durable medical equipment and supplies. The New York State’s Office of the Medicaid Inspector General (OMIG) recently released the agency’s 2012-2013 workplan. The agency’s focus remains firmly on fighting fraud, waste and abuse, compliance and self-disclosure, and provider education. We look closer at how the OMIG plan impacts pharmacy and durable medical equipment (DME) businesses. |
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