The Centers for Medicare & Medicaid Services (CMS) recently announced its intent to begin the Prior Authorization of Power Mobility Devices (PMD) Demonstration. For orders written on or after Sept. 1, prior authorization will be required for scooters and power wheelchairs for people with fee-for-service Medicare who reside in California, Illinois, Michigan, New York, North Carolina, Florida, and Texas — seven states known to have high Medicare fraud and abuse rates. (more…)
August 9th, 2012
National Government Services, a durable medical equipment Medicare administrative contractor (DME MAC), is returning paper claims when providers fill in item 33b. The DME MAC for Jurisdiction B reports an increase in the number of paper claims returned to suppliers because item 33b of the CMS-1500 paper claim form contained either the Provider Transaction Access Number (PTAN) or National Provider Identifier (NPI). (more…)
It isn’t every day a Medicare administrative contractor (MAC) says it will cover a procedure that has neither a specific CPT® code describing it nor any concrete proof that the medical intervention is even useful. On July 16, however, Palmetto GBA did exactly that when it posted a policy update for percutaneous endovascular cardiac assist procedures and devices.
Effective for dates of service on or after Sept. 1, 2011, the jurisdiction 1 Part B MAC will cover the percutaneous insertion of an endovascular cardiac assist device and the device itself.
Coverage will be allowed for (but not exclusively) the following ICD-9-CM codes:
- Cardiogenic shock, reported with 785.51
- Severe decompensated heart failure with threatening multi-organ failure, represented by one of the following:
- 428.21 Acute systolic heart failure
- 428.23 Acute or chronic systolic heart failure
- 428.41 Acute combine systolic and diastolic heart failure
- 428.43 Acute or chronic combined systolic and diastolic heart failure
- 429.4 Functional disturbances following cardiac surgery
- 997.1 Cardiac complications, not elsewhere classified
When submitting a claim to Palmetto for an endovascular cardiac assist procedure, report CPT® 33999 Unlisted procedure, cardiac surgery and enter “Impella” or “Tandem Heart” in item 19 of the CMS-1500 claim form or its electronic equivalent.
Source: Palmetto GBA
July 26th, 2012
As a result of an Office of Inspector General (OIG) June 2012 report, providers and suppliers can expect increased scrutiny of high utilization claims for test strips and lancets. In response to the report, which estimates contractors overpaid as much as $271 million for these types of claims in 2007, contractors stated they have taken, or plan to take, corrective action.
June 29th, 2012
The Centers for Medicare & Medicaid Services’ (CMS’) July Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) update includes changes retroactive to Jan. 1, 2012.
June 1st, 2012