Medicare Compliance & Reimbursement

A common working file edit flagging too many immunosuppressive drug claims should soon get fixed by the durable medical equipment regional carriers. In an Oct. 17 one-time notification, the Centers for Medicare & Medicaid Services points out that an edit designed to weed out duplicate immunosuppressive drug claims isn't working properly. The problem: The edit sends out an alert whenever immunosuppressive drug claims are submitted along with other, non-immunosuppressive drug DME items on the same date of service by the same supplier (Change Request 2910; http://oig.hhs.gov/fraud/advisoryopinions/aofaq.html). The agency mandates that the edit be fixed by April 1, 2004. In other recent manual updates, CMS: implements edits to enforce calendar year allowances on therapeutic shoe inserts for diabetics (CR 2746; http://oig.hhs.gov/fraud/advisoryopinions/aofaq.html); implements jurisdictional payment policies for physician fee schedule payments and for anesthesia payments (CR 2912; http://oig.hhs.gov/fraud/advisoryopinions/aofaq.html); and issues the October 2003 update to the Health Care Provider Taxonomy Code (CR 2901; http://oig.hhs.gov/fraud/advisoryopinions/aofaq. html).