Tag Archives: Audits

Jurisdiction C DAC needs help

Jurisdiction C audit task force needs your help. They have been working diligently with CGS on specific focus areas that can have the biggest impact in reduction of denials.  During collaboration discussions with CGS and audit task force meetings they have developed a narrowed focus to have an immediate impact on front end technical errors.

o   Proof Of Delivery-Any issues where CGS is not recognizing the documents we send in as valid proof of delivery.  These include missing them entirely, quantity issues, etc.

o   Detailed Written Orders-CGS not recognizing the DWO in the audit packets and cannot locate all the elements necessary.  Bigger issues now with WOPD requirements.

o   PAP Denials-Sleep study not signed, physician not certified to interpret, and any other PAP technical errors you are seeing.

If you have specific errors that the audit team can submit please contact  Laura.williard@advhomecare.org or peggy.walker@vgm.com  NO patient information – just dcn numbers and a brief statement of what has happened.

Denied Medicare Claims Overturned Following OMHA

Denied Medicare Claims Overturned Following OMHA

 WATERLOO, Iowa – February’s OMHA Appellant Forum in Washington, D.C., afforded VGM members the opportunity to question Chief Judge Nancy Griswold about the tumultuous DME audit process.

Some members, who had submitted denials they thought were inappropriate or inaccurate in advance of the event, are experiencing even better outcomes.

Prior to the event, Peggy Walker of VGM’s U.S. RehabR, requested that providers send her examples of second-level denials that resulted from clerical errors or obvious oversights.

Peggy prepared the documents in a packet she submitted along with her testimony that day at the forum.

CMS sent the examples to C2C Solutions, the second level contractor that had previously denied the claims.

Of the claims submitted, 70 percent of them were overturned fully or partially in favor of providers, indicating that the original denials were made in error.

C2C replied directly to Walker, and she will notify providers of the results.

“C2C Solutions was willing to look over the denials that were made in error,” said Walker.“The errors were technical errors that were reviewed inappropriately by the first two levels of appeals.”

Any provider who has a claim denied because of an issue that was clearly a technical mistake is encouraged submit the claim to Walker for review and possible reopening.

Click the form below and once completed, fax to Walker at 877-907-3862.

2nd-Level Contractors Special Project Request Form