Category: Dan Fedor

Some Medicare Advantage Plans NOT Honoring the Beneficiaries First Month Purchase Option for Complex Rehab Power Chairs

Some Medicare Advantage Plans NOT Honoring the Beneficiaries First Month Purchase Option for Complex Rehab Power Chairs There has been an ongoing issue with Medicare Advantage plans that is significantly impacting complex rehab providers. As many beneficiaries migrate to Advantage plans, many providers are accepting agreements to service those patients. These plans state that they …

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Great News: Mass Adjustment Payments are Starting!

By Ronda Buhrmester and Dan Fedor, VGM Reimbursement Specialists We are hearing from DME providers that they are starting to receive payments from both DME MACS Noridian and CGS. Noridian’s dashboard is reporting 6.1 percent of Jurisdiction D has been completed as of July 5. Jurisdiction A has completed 11.4 percent of their adjusted claims …

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How to Navigate a Medicare System Limitation for Efficient Claim Submission

There is an ongoing issue with the Medicare processing system (VMS) denying accessories when more than nine line items are submitted. Due to a system limitation, when more than nine line items are submitted on one claim, the MAC processing system (VMS) splits the claim, and if the accessory codes are processed before the base item …

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The KU modifier has been SAVED!

In a recent article, we warned that the protection of group 3 accessories from competitive bid pricing was to expire on June 30, 2017 and with that, the KU modifier would have been eliminated for dates of service on or after July 1. Based on the recent announcement that CMS has rescinded implementation of CB …

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If Suppliers Submit Assigned Claims, Then the Fee Schedule is Adequate Payment?

By Dan Fedor, Reimbursement Specialist, U.S. Rehab According to the following release from CMS, it appears that their logic is if suppliers submit assigned claims, then the fee schedule is adequate payment. But, we know that is not the case, as the fee schedule is NOT adequate payment for most codes! Assignment Rates CMS Releases 2016 Assignment Rates …

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