Following up on a previous Smart Brief announcement, regarding upcoming changes in the contractors who will serve as the Durable Medical Equipment Medicare Administrative Contractors (DME MACs), AOPA has learned about additional details regarding the transition of DME MAC Jurisdiction A and Jurisdiction B responsibilities. The denial of the NGS protest of the Jurisdiction B […]
As AOPA reported earlier, CGS, the current Jurisdiction C DME MAC contractor, was awarded the Jurisdiction B contract on September 3, 2015. However, National Government Services (NGS), the current Jurisdiction B DME MAC, filed a formal protest causing CMS to halt the transition pending a review of the contract award by the Government Accountability office […]
On December 16, 2015, the Centers for Medicare and Medicaid Service (CMS) announced that Noridian HealthCare Solutions, LLC. was awarded a contract to serve as the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC). Noridian currently holds contracts to serve as the Jurisdiction D DME MAC as well as the Pricing, Data Analysis, […]
On December 29th, the Centers for Medicare and Medicaid Services (CMS) released the long anticipated final rule regarding Medicare prior authorization of certain DMEPOS, including most lower limb prostheses. The final rule, which will be published in the December 30, 2015 Federal Register, will be implemented 60 days after it publication. AOPA has reviewed the […]
On Wednesday, December 16th, President Obama signed a short term spending measure that will allow the Federal government to continue to operate until December 22, allowing Congress to finalize its long anticipated Omnibus appropriations and tax break extender legislation that will fund the Federal government for the remainder of the 2016 fiscal year. Two important […]
The Pricing, Data Analysis and Coding contractor (PDAC) has announced that due to a change in the 2016 descriptor verbiage for L1902 and L1904, it will initiate a new coding verification for any ankle gauntlet style devices that contain joints that are currently listed on the PDAC site under L2999. Read the announcement. It is […]
On November 23, 2015, the Centers for Medicare and Medicaid Services (CMS) released the 2016 Medicare DMEPOS fee schedule. As expected, Medicare fees for orthotic and prosthetic devices will be slightly lower in 2016 than they were in 2015. The annual update to the Medicare O&P fee schedule is based on a combination of the […]
It has been remarkably quiet on the Recovery Audit Contractor (RAC) front for the last 18 months or so. As a result of the original RAC contracts coming to an end and new RAC contract proposals being submitted and reviewed, the number of additional documentation requests (ADRs) has been reduced significantly. CMS advised its original […]
The Centers for Medicare and Medicaid Services (CMS) has released the new HCPCS codes for 2016. There were no L-codes added or deleted for 2016. There were two minor verbiage changes for codes L1902 and L1904, which describe pre-fabricated and custom fabricated ankle gauntlet style devices respectively. Below is a breakdown of the code descriptor […]
The White House just announced that CMS “will not finalize” the July 16, 2015 Draft LCD. That may be clarified further when comparable announcement text from both CMS and from the DME MACs are released and can be analyzed. The White House report appears to confirm the information that AOPA shared at the recent San […]
