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Category: Audits

A Recap of 2017 Legislative Efforts and Continuing the Fight

There have been several key developments in the past several weeks, which our grassroots coalition must continue to push forward to gain their legislators support. Congressional Letter to HHS Secretary Price The letter being led by Reps. Cathy McMorris Rodgers (R-Wash.), Dave Loebsack (D-Iowa), Lee Zeldin (R-N.Y.), and Diana Degette (D-Colo.) is calling for reforms

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Legislative Alert: Prior Authorization Bill Reintroduced in the U.S. House

Legislative Alert: Prior Authorization Bill Reintroduced in the U.S. House Rep. Marsha Blackburn (R-Tenn.) Rep. Marsha Blackburn (R-Tenn.) has reintroduced a bill that would require a prior authorization for high dollar durable medical equipment. The bill title for H.R. 2445 will be the DMEPOS Access and Transparency Act of 2017, also referred to as the DATA

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Improvements to the Adjudication Process of Serial Claims

By Kelly Grahovac, The van Halem Group A major win for DME suppliers was announced yesterday (Thursday), as CMS released information regarding improvements to the adjudication process of serial claims. Effective April 7, 2017, CMS has implemented changes to improve the processing and adjudication of recurring (monthly) claims for capped rental and certain inexpensive and

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Medicare Appeal Backlog Could Be Cleared by 2019, HHS Claims

By Matthew Loughran | November 8, 2016 10:28AM ET Nov. 8 (BNA) – The multi-year backlog of Medicare administrative appeals could be cleared up by the end of fiscal year 2019, according to an HHS filing in federal district court yesterday. The Health and Human Services Department asked the U.S. District Court for the District of Columbia

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CMS announces next round of RAC contracts

Announcement from on 10/31/2016 CMS has awarded the next round of Medicare Fee-for-Service Recovery Audit Contractor (RAC) contracts to: Region 1 – Performant Recovery, Inc. Region 2 – Cotiviti, LLC Region 3 – Cotiviti, LLC Region 4 – HMS Federal Solutions Region 5 – Performant Recovery, Inc. Maps depicting the new regions and related

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Congresswoman Barbara Comstock visits Wheelchair and Scooter Repair in Virginia

The August Recess is in full swing and providers are making it count by meeting with elected officials. This week Rep. Barbara Comstock (R-Va.) visited Wheelchair and Scooter Repair (WSR) in Manassas Park, VA to discuss challenges that DME providers are facing. The discussion revolved around issues with the audit process and reimbursement reductions due

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