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Category: Reimbursement

April update to the DMEPOS rural zip code file

As HME providers are most aware, last October CMS released the zip codes for the non-bid areas that will be impacted by the national expansion of competitive bidding, which went into effect Jan. 1, 2016.  CMS also designated rural zip codes, which covered 16,285 zip codes (37.8 percent of the total); these areas received rates

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MAMES President, Pat Naeger featured in Southeast Missouri Business Today

Recently, the DME industry has seen a positive uptick in the amount of local and rural press directed towards the cuts to Medicare DMEPOS reimbursement. From VGM partnering with the SBA to coordinate the Regulatory Fairness Hearings for rural small businesses, to active DMEPOS and CRT providers ringing the bell to make these issues heard;

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Did you miss Mark Higley’s Webinar on the Round 2 Recompete?

We have posted Mark Higley’s webinar discussing everything you need to know for Round 2 Recompete. At the top of the homepage on www.vgmncbservices.com you can view the webinar and corresponding PowerPoint for your convenience. With the deadline extension to complete contract offers for Round 2 Recompete to Thursday, March 31, 2016, there is still

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Medicare fee schedule as of Jan. 1, 2016

HME providers should be aware that as of Jan. 1, 2016 CMS began the “initial phase in” of downward adjustments to the Medicare fee-for-service fee schedule amounts for HCPC codes included in Rounds 1 and 2 of the competitive bidding program. On Nov. 23, 2015, CMS released the 2016 DMEPOS and Parenteral and Enteral Nutrition

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From the Reimbursement Team: Ability to send C2C form (Reconsideration)

Effective immediately, DME suppliers can submit the C2C Solutions Provider Inquiry Form directly to C2C. Remember this form is to be used ONLY when you believe C2C Solutions has overlooked documentation submitted and did not process your appeal correctly. Click here for C2C provider inquiry form. Complete the entire form, leaving out any HIPAA information.

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From the Reimbursement Team: Good News -Post-Pay Audits

In a recent MLN article, SE1521 released August 19, 2015, there is good news for the DMEPOS industry. On Post-Payment Review/Audits at redeterminations and reconsiderations, the reviews are limited to the reason the claim or line item at issue was initially denied. This applies to ZPIC, RAC, MAC, CERT, post payment audits. This is for

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From the desk of Mark Higley: Fall Seminar Series starts next week. Reserve your seat today!

Fall Seminar Series mission is to deliver relevant and timely information for our members to help them COMPETE, PROSPER and SUCCEED so they can continue to do what they do best…take care of patients. Register today for a seminar nearest to you. Click here to view the list of cities Mark and the group will

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From the Reimbursement Team: Another Audit Contractor………Whaaaat?

Strategic Health Solutions (SHS) is a supplemental medical review contractor hired by CMS. When you go to their website, www.strategichs.com under contracts SMRC, is a slogan in large font, “Protecting the Medicare Trust Fund”. I chuckle at this because here we have another specialty review contractor that is being paid by CMS to perform audits

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