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OIG Adds Oxygen and Wheelchair Repairs to the Work Plan

The Office of Inspector General (OIG) added two new DMEPOS items to their Work Plan for October 2024. See below for details.  Medicare Payments to Suppliers for Oxygen and Oxygen Equipment Medicare covers reasonable and necessary durable medical...

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CMS Updates to Lists Related to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Conditions of Payment [CMS-6081-N]

By Donna Youngblood, RN, Clinical Consultant at The van Halem Group CMS released its long awaited Master List on January 12, 2022 with new codes being added to both the Master list and Required List. In addition, they have added Power Operated Vehicles...

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NCD changes for Home Oxygen Therapy

In a memo just released by the Centers for Medicare & Medicaid Services (CMS), it was announced that upcoming changes were coming to two separate, but medically related, National Coverage Determinations (NCDs). Changes include removing the NCD for Home...

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FDA releases safety information related to the Philips recall

On June 30, 2021, the U.S. Food and Drug Administration (FDA) published a safety communication to their website. The FDA communication urges patients using the affected devices to talk to their health care providers to determine a suitable treatment...

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Noridian Frequently Asked Questions - Philips Respironics Respiratory Products Recall

On June 14, 2021, Philips Respironics announced the voluntary, global recall of an estimated 4 million continuous positive airway pressure (CPAP) devices, bilevel respiratory assist devices (RADs), and ventilators. The situation is quite fluid; consequently,...

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CMS allows multi-function vent for upgrade

By Carrie Nienberg, RN, Director of Clinical Operations Effective immediately, you as a supplier may provide and bill E0467, multi-function ventilator, as an upgrade when the beneficiary only qualifies for the ventilator. Until now, the beneficiary...

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SMRC To Perform Data Analysis and Reviews of Oxygen and Oxygen Equipment During Noncovered SNF Stays

By Sandra Gauron, Appeals Coordinator Pursuant to the Office of the Inspector General (OIG) report (OEI 06-16-00380), in which the OIG identified potential inappropriate payments to DME suppliers during non-covered SNF stays, CMS has tasked the SMRC...

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Are inhalation drugs the next OIG Six Year Lookback Audit?

Since 2010, the CMS’s Comprehensive Error Rate Testing (CERT) program has identified nebulizers and related drugs (i.e., inhalation drugs) among the top 20 supplies with the highest improper Medicare payments. Based on prior reviews, the Office of...

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PAP Supplies added to OIG Work Plan: What You Need to Know

By Sandra Gauron, Appeals Coordinator Part of the Office of Inspector General's (OIG) objectives are to promote economy and efficiency and to detect and prevent fraud, waste and abuse.  In order to do this, they develop and continually update their...

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Preventing Replacement Positive Airway Pressure (PAP) Supply claim denials

By Donna Youngblood RN, BSN, CPC There are many different scenarios for patients requiring replacement PAP supplies. Common scenarios include the need for new supplies during the 13-month rental after initiation of PAP therapy, needing supplies for...

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