CGS to Conduct More Pre-Payment Reviews
- By Laurie Watanabe
- Apr 29, 2014
CGS, the Jurisdiction C DME MAC, has announced it will start "a service-specific Medical Review edit" for 10 DME-related HCPCS codes.
Several types of wheelchairs are to be included.
The affected codes are as follows:
E0250: Fixed-height hospital bed
E0255: Variable-height hospital bed
E0607: Home blood glucose monitor
E0730: Transcutaneous Electrical Nerve Stimulation [TENS] device
E0748: Osteogenesis stimulator, electrical, non-invasive, spinal applications
E2402: Negative pressure wound therapy electrical pump, stationary or portable
E2510: Speech-generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access
K0001: Standard manual wheelchair
K0002: Standard hemi height manual wheelchair
K0003: Lightweight manual wheelchair
In the April 22 announcement to stakeholders, CGS said it was conducting the reviews "to verify that suppliers are complying with the Affordable Care Act Section 6407 requiring a detailed written order prior to delivery and the written order guidance published in CMS Program Integrity Manual Chapter 5, Section 5.2.3."
As with other types of Medicare DME reviews, CGS says providers will be asked for additional documentation to support the affected claims.
Among the types of documentation that providers will be asked for are the detailed written order, delivery documentation, a copy of the Advance Beneficiary Notice of Non-Coverage if applicable, and "any other pertinent records."
Suppliers will have 45 days from the date of the letter to supply the additional documentation. CGS will deny the claim if the provider fails to supply the requested documentation within that timeframe.
Laurie Watanabe is the editor of Mobility Management. She can be reached at firstname.lastname@example.org.