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Category: Reimbursement

From the Reimbursement Team: Medicare Establishes Set Fees for Custom Cushions (E2609) and Backs (E2617)…. and it DOESN’T Sit Well!

This is a heads up to those who provide custom cushions (E2609) and backs (E2617) to Medicare beneficiaries! The Jurisdiction B and C DME MAC has decided to develop set fees for these custom items and did this internally without notice to the provider community. As of today DME A and D has NOT implemented this change.

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From the Reimbursement Team: Prior Authorization for PMD Codes K0856 and K0861 to Begin in March 2017!

CMS has announced that prior authorization (PA) for power wheelchair codes K0856 (Group 3 single power option) and K0861 (Group 3 multiple power option) will begin in March in New York, Illinois, Missouri and West Virginia. It is expected to go nationwide in July. PA requests from New York, Illinois, Missouri and West Virginia will

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From the Reimbursement Team: Decide NOW – Will You Be a Par or Non-par Provider in 2017?

With the end of the year approaching fast, now is the time to decide if you will be a participating (par) or non-participating provider. Before making your decision, we highly encourage you to watch this video, read the article below and download these slides from reimbursement experts Ronda Buhrmester and Dan Fedor. Unlike golf, being

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In Case You Haven’t Heard – News For Jurisdiction C and D Suppliers

At the Medtrade Spring Jurisdiction D council meeting, C2C Innovation Solutions shared updates with the supplier community.  Currently there is a demonstration project that consists of two phases in Jurisdiction C and D only for diabetic testing strips and oxygen equipment. The first phase has allowed suppliers the opportunity to participate in a formal recorded

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Non-Invasive Ventilator Review

Non-Invasive ventilators (NIV) have been circling back with questions on documentation requirements.  This means it’s time to review the requirements needed for NIV coverage particularly since there is not a medical policy (LCD). Here are helpful tips regarding ventilator coverage: Generally covered for treatment of neuromuscular disorders, thoracic restrictive diseases, or chronic respiratory failure secondary

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Mark Higley’s commentary: Contract offer responses due today in Connexion

After the extension of time allowed for companies to accept their Round 2 Recompete bids, today is the final day to do so. As in previous competitions, there will likely be an additional round of contract offers in many CBAs.  To be clear, those suppliers with current offers in Connexion must complete the response by

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