The revised Advance Beneficiary Notice (ABN) form is now required as of January 1, 2012. The ABN form is provided to Medicare beneficiaries by providers such as skilled nursing facilities, physicians and others when the provider believes that Medicare may not cover and reimburse the services to be provided. This notice of noncoverage is provided to the beneficiary and the revised notice Form CMS-R-131 can be accessed through the attached link with additional information on its use. http://www.cms.gov/BNI/02_ABN.asp
Category Archives: Durable Medical Equipment
Revised Advance Beneficiary Notice Use Now Required
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Posted in Continuing Care, Durable Medical Equipment, General, Health Care, Health Care Providers, Home Health, Hospital, Long Term Care, Medicare, Nursing Facility, Occupational Therapy, Out-Patient Care, Physicial Therapy, Physicians, Post Acute Care, Rehabilitation, Skilled Nursing Facility, Supplier
CMS Demonstration Project to Require Prior Authorization for Certain Medical Equipment
Begining in January of 2012, a CMS demonstration program will start requiring prior authorization for certain medical equipment before Medicare beneficiaries can recieve the equipment. CMS is initiating a three-year demonstration program as a program integrity initiative in states that CMS believes have higher instances of fraud and error-prone providers. The initial seven states are – CA, FL, IL, MI, NY, NC and TX
The demonstration will be implemented in two phases. During the first phase (the first three to nine months), the Medicare Administrative Contractors will conduct prepayment reviews on certain medical equipment claims. The second phase, for the remainder of the three-year demonstration, will implement prior authorization, as a mechanism to prevent improper payments and deter the fraudulent provision of items or services.
A CMS Fact Sheet on this demonstration and other program integrity intiatives can be found here —-> CMS Fact Sheet
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Posted in Durable Medical Equipment, Fraud and Abuse, Health Care, Health Care Providers, Health Insurance, Participation, Payers, Program Integrity, Regulatory Compliance, Reimbursement
OIG Work Plan 2012: Durable Medical Equipment, Prosthetics, Orthotics and Supplies
On October 5, 2011, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) released its Work Plan for the fiscal year 2012. The Work Plan describes the OIG’s new and ongoing initiatives for the upcoming fiscal year. Typically, these initiatives focus on areas that have been recent problem areas for the OIG. Several of the OIG’s new and ongoing initiatives are of particular interest to Durable Medical Equipment, Prosthetics, Orthotics and Supplies (“DMEPOS”) suppliers.
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Posted in Durable Medical Equipment, General, OIG
CMS Issues – MLN Matters on Expansion of Durable Medical Equipment (DME) Supplier Standards
On 2/1/2011, CMS Issued MLN Matters No. SE1032 entitled “Expansion of Durable Medical Equipment (DME) Supplier Standards”
The article provides information for DMEPOS suppliers on the new expanded CMS enrollment standards that suppliers must meet in order to establish and/or maintain billing privileges in the Medicare Program. Continue reading
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Posted in Durable Medical Equipment, General, Medicare, MLN Matters, Provider Enrollment - Medicare, Supplier
Benesch
Ari J. Markenson, JD, MPH
Janet K. Feldkamp RN BSN LNHA CHC JD
Robert W. Markette, Jr. CHC
W. Clifford Mull
Frank W. Carsonie
Daniel J. O'Brien
Benjamin J. Parsons
Meredith L. Rosenbeck
Alan E. Schabes
