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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 routinely purchased (IRP) items.

Prior to April 2017, if a monthly rental claim was denied and then appealed separately, the claim was adjudicated independently and without reference to the other claims in the series. As a result, one month could pay while claims for other months in the rental period remained denied and pending at various other levels of appeal. Industry leaders have been working hard to get CMS to see the light and make changes that would get all monthly claims in the rental period adjusted and paid following an effectuation for any month. CMS listened and has directed the DME MACs to change their processes for adjudicating serial claims!

What does that mean?

Click here to see the rest of the article from The van Halem Group.