Billing & Reimbursement

One of the most important “profit centers” of a supplier is its compliance program. While a compliance program does not directly generate income for the supplier, a functioning compliance program will assist the supplier in (i) retaining the money it has previously been paid and (ii) not having to pay consultants and attorneys to assist in responding to a recoupment demand. Further, a functioning compliance program reduces the risk of (i) a whistleblower lawsuit being filed by

DME suppliers are currently preparing for Competitive Bid Round 2021. Only certain product categories are included in competitive bid. Please note, this is the first round for off the shelf back and knee braces to be competitively bid.  Bidder registration period and the bid window will likely open in June 2019 (this date may change).  EW members who are planning to participate in this current round of bidding, prepare now. VGM has put together tools to help our members go through

A Defense Department watchdog last year found that Tricare overpaid more than $16 million for breast pumps. Tricare has now scaled back its coverage to cut out "luxury or deluxe" features, like connectivity to cars and smartphones, and associated items like nursing bras, cleaning supplies and over-the-counter ointments. New moms will also be allowed to receive one breast pump, whereas the previous policy allowed for two. This new policy comes after the 2018 Office of Inspector General investigation

On January 30, 2019, CMS posted to their website that “As of January 30, 2019, there are no active Medicare Provider Enrollment Moratoria in any State or U.S. territories.” The Provider Enrollment Moratoria Waiver Demonstration will end when the moratoria expires. Since July 2013 a moratorium has been in effect that prevented home health agencies (HHAs) from enrolling into the Medicare, Medicaid, and the Children’s Health Insurance Programs (CHIP) in particular geographic

On January 23, 2019, Performant Recovery, the National DMEPOS RAC, added Pneumatic Compression Devices to their approved issues list. According to their website, Performant Recovery will perform complex reviews to determine if the pneumatic compression device is reasonable and necessary for the patient’s condition based on the documentation in the medical record. Claims that do not meet the indications of coverage and/or medical necessity will be denied. Read more from

At the beginning of the year, most of us make resolutions. Have you thought about putting together resolutions for billing and reimbursement? The van Halem Group has put together a series of articles on best practices for the new year. Documentation resolutions should include your problem areas, like illegible signatures, illegible provider documentation, inconclusive date of receipt, and issues with identifying the patient on the medical records.  Read the whole article on van Halem's

Same or similar denials occur when claims information is checked against the patient’s CMN history. This will indicate when equipment is “same or similar” to that piece of equipment being billed on the claim. These types of denials can be avoided early on when providing DME equipment to patients. The most important part in preventing this type of denial is by having a thorough intake process. Suppliers are encouraged to use an intake form to assure all necessary information is