In Audit
May 14th, 2019
If you want to smooth reimbursement claims for durable medical equipment, CGS offers 28 documentation checklists that identify what must be included. Recently updated, these checklists include the following items and services: Enteral nutrition Glucose monitors and supplies Hospital beds and accessories Immunosuppressive drugs Large volume nebulizers and inhalation drugs Lower limb prostheses Manua...
In Billing
May 8th, 2018
Knee orthoses are one of the highest sources of errors, a letter from CGS to providers warns, and the Medicare Administrative Contractor’s (MAC) wants providers to be more careful with documentation and reporting. How Do We Get Paid? The Centers for Medicare & Medicaid Services (CMS) requires medical necessity for the diagnosis or treatment of the ...
In Coding
Aug 16th, 2016
Noridian Healthcare Solutions is initiating a service-specific targeted review for mental health CPT® code 90834 Psychotherapy, 45 minutes with patient and/or family member. The Medicare administrative contractor (MAC) says data analysis has identified a potentially high use of this code in Jurisdiction E (California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands). Are ...
Mar 6th, 2015
A fairly new therapy, still under investigation by the U.S. Food and Drug Administration, is getting a little more respect these days. Until recently, insurance carriers considered fecal microbiota transfer (FMT) a statutorily non-covered service for patients suffering from clostridium difficile infection (CDI). The tide is turning. Those at Risk for CDI CDI is a ...
May 23rd, 2014
A service-specific prepayment review of HCPCS Level II code J7507 Tacrolimus, immediate release, oral, 1 mg conducted by CGS, durable medical equipment Medicare administrative contractor (DME MAC) for jurisdiction C, shows a 44 percent error rate for fourth quarter 2013 claims and a 45 percent error rate for first quarter 2014 claims. The primary reason ...