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Jurisdiction D DME MAC Publishes Results of Pre-Payment Review of Ankle Foot Orthoses, Knee Orthoses, and Spinal Orthoses

Noridian, who serves as the Jurisdiction D Durable Medical Equipment Medicare Administrative Contractor (DME MAC), has released the most recent quarterly results of its ongoing pre-payment review of claims for several codes. For AFOs described by HCPCS codes L1960, L1970 and L4360: from December 2015 through March 2016, a total of 1008 claims were reviewed; […]

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 […]

“Best ever” Policy Forum Wraps up

The 2016 Policy Forum and O&P Legislation Writing Congress was a huge success!  Initial feedback has been overwhelmingly positive about the new experience of drafting a bill to take to the Hill.  Participants broke into groups to discuss their highest priorities for legislation, and  after reconvening, the resulting “Prosthetic and Orthotic Care Modernization Act of 2016″ focuses on […]

Bill Introduced to Place Moratorium on CMS’ LCD Lower Limb Proposal

On April 25, Representative Ellmers (R-NC-02) introduced HR 5045: Preserving Access to Modern Prosthetic Limbs Act of 2016.  The bill is “to impose a moratorium on the implementation of a proposed Medicare local coverage determination on lower limb prostheses”.  The bill places a moratorium until June 30, 2017 on implementing the July 16, 2015 Local […]

CMS Announces Update to Interest Rate for Medicare Overpayments and Underpayments

The Centers for Medicare and Medicaid Services (CMS) has announced that effective April 19, 2016, the interest rate that will be applied to Medicare overpayments and underpayments will be 10.00%, representing an increase of 0.25% since the last quarterly update. Federal regulations require the Medicare interest rate to be adjusted quarterly based on information published […]

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