DME MACs Revise Knee Orthosis Policy

The DME MACs have recently published a revision to the Knee Othosis Local Coverage Determination (LCD) and Policy Article (PA) that will be effective for dates of service on or after June 2, 2016. The primary revisions to the LCD and Policy article include the addition of ICD-10 diagnosis codes that allow providers to indicate […]

CMS Issues Press Release on DMEPOS Payment Amounts

CMS has issued a press release, “Monitoring Data Shows Adequacy of New Payment Amounts for DMEPOS in Non-Competitively Bid Areas”.  The content of the CMS Press Release is below.   The press release is available on the CMS website. Access the monitoring data broken down by state.

CMS Releases Proposed Rule for 2017 SNF Prospective Payment System

On April 25, 2016, the Centers for Medicare and Medicaid Services (CMS), published the annual proposed rule that will govern Medicare coverage of Skilled Nursing Facility (SNF) services through its established Prospective Payment System (PPS). Included in the proposed rule is an opportunity for the public to suggest additions to the list of HCPCS codes […]

Revised Limitations on the Scope of Review for Redeterminations & Reconsiderations

The Center for Medicare and Medicaid Services (CMS) has recently issued a revised directive to its contractors handling appeals that are a result of a “complex prepayment reviews, complex postpayment reviews or automated post payment reviews”. CMS has informed the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and the Qualified Independent Contractor (QIC) that […]

OGR Release Letter Criticizing LCD; and Wrap up of Last Week’s Events

Last week was a remarkable week for O&P! We had FOUR exciting things happen: 1.) AOPA hosted a press event to call attention to the Lower Limb LCD’s effects in the private sector; 2.) A bill was introduced that would place a moratorium on implementing an LCD Proposal; 3.) AOPA hosted the Policy Forum and […]