Noridian Healthcare Solutions, LLC (Noridian), as the Supplemental Medical Review Contractor (SMRC) for the Centers for Medicare and Medicaid (CMS), announced that they are conducting post-payment review of Medicare DME surgical dressing claims billed with dates of service from January 1, 2023, through December 31, 2024.
Why Surgical Dressings?
Surgical dressings are covered under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Benefit. Coverage is provided for primary and secondary surgical dressings used on the skin on qualifying wound types such as a wound caused by, or treated by, a surgical procedure or after debridement of the wound. Types of surgical dressings include, but are not limited to, alginate or other fiber gelling dressing, collagen or wound filling dressing, and foam filling dressing. The relevant part of the surgical dressings benefit establishes two separate benefit criteria:
- The necessity for and definition of a qualifying wound
- The requirements necessary for any product to be classified as a surgical dressing.
In the 2023 Comprehensive Error Rate Testing (CERT) Improper Payment Report, surgical dressings had an associated improper payment rate of 62.1%. Prior work done by the Supplemental Medical Review Contractor (SMRC) demonstrated a claim error rate of 91%.
The SMRC is tasked to perform data analysis and conduct medical record reviews on surgical dressing claims billed with dates of service January 1, 2023, through December 31, 2024. The SMRC will conduct medical record reviews in accordance with applicable waivers, flexibilities, statutory, regulatory, and sub-regulatory guidance.
The following HCPCS will be included in the postpayment review: A6010, A6011, A6021-A6024, A6196-A6199, A6209-A6215
Need Some Help?
The van Halem Group’s team of experts are here for you! If you receive an audit request from the SMRC we can help! Our clinicians can review your patient files and advise of any missing documentation and help assess your risk. If the audit findings reveal an overpayment is due, our appeals team can manage your claims through the appeals process. Contact us today to learn how we can help.