Tag: LCD

WASHINGTON – CMS has published a new local coverage and policy article for oxygen and oxygen equipment, AAHomecare reports.  Here is a link to the LCD: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33797  Here is a link to the policy article: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52514  The new LCD goes into effect Jan. 1.  CMS is not required to provide a comment period, because the LCD contains what...

WASHINGTON - Medicare made a clerical error when it said it considered wheelchair trays, tables or similar products convenience items. The agency said claims for E0950 would be denied as statutorily non-covered, no benefit, according to an LCD and policy article revision posted by the DME MACs on March 16. The article was corrected on March 30. The change was set to take effect retroactively on Jan. 1, 2017. Concerns with the change included the medical necessity of these items and the timing. “They...

WASHINGTON - CMS has taken a step back from its controversial plans to change the coverage requirements for lower limb prostheses. The agency's DME MACs released a draft local coverage determination in July, setting off a chain of events that included a public hearing, a protest, high-stakes meetings and a “We the People” petition. “Both CMS and its contractors have heard your concerns about access to prostheses for Medicare beneficiaries,” the agency stated in an...

WASHINGTON - A prepayment review of power wheelchair claims processed in Jurisdiction B resulted in an 80% error rate, according to National Government Services (NSG), the DME MAC there. Of 1,022 claims processed from Oct. 1 2012�-Dec. 31, 2012, 122 were paid in full, while the remaining claims were completely or partially denied, according to the review. The most common reasons for denials were: Local Coverage Determination (LCD) criteria not met; face-to-face examination with a physician not...

WASHINGTON - A Senate Aging Committee hearing this week will focus on new Medicare prior authorization requirements for power mobility devices (PMDs). The hearing, scheduled for Wednesday, Sept. 19, at 2 p.m., will review a three-year CMS demonstration project requiring prior authorizations for PMDs in seven states. The states under the microscope—California, Illinois, Michigan, New York, North Carolina, Florida and Texas—are where government officials believe PMD fraud is most prevalent....

NASHVILLE, Tenn. - CGS, the DME MAC for Jurisdiction C, posted changes to the local coverage determination (LCD) for oxygen on Sept. 13. Two big changes: exercise testing must be supervised by a physician or other qualified individual; and home sleep testing requirements are limited to standalone overnight pulse oximetry. The revised LCD goes into effect Oct. 1, 2012.