Failing to Collect Medicare Copay, Coinsurance and/or Deductible may be a Violation of Federal Laws

Do you know failing to collect or failing to document a “reasonable collection effort” to collect the Medicare deductible, and/or coinsurance may violate Federal Anti-Kickback Statue (AKS), Beneficiary (Patient) Inducement Statute and False Claim Act (FCA)? According to Chapter 23 of the Claims Processing Manual section 80.8.1 (CPM), “Physicians or suppliers who routinely waive the…

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Medicare recently updated the refill request requirements with an effective date of January 01, 2024

Medicare recently updated the refill request requirements with an effective date of January 01, 2024. All the applicable local coverage determinations (LCDs) have been updated to reflect the below: For DMEPOS items and supplies provided on a recurring basis, billing must be based on prospective, not retrospective use. For DMEPOS products that are supplied as…

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Catching Up with Medicare Mobility Reimbursement News

August 10, 2023 – Effective Jan. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) updated the Medically Unlikely Edit (MUE) for HCPCS code E2394 (Power wheelchair accessory, drive wheel, excludes tire, any size, replacement only, each), from two (2) units per date of service to one (1) unit per date of service. Most…

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Stating Your Case – Best Practices for Challenging Prior Authorization Determinations and Denials

With the COVID-19 declared public health emergency (PHE) now behind us, many health care providers have already returned to business as usual. While there are lingering effects of the PHE, such as increased costs related to supply chain-related issues and staffing shortages, payors have, for the most part, resumed pre-PHE operations by eliminating most of…

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