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DME Compliance

Perform a prospective or retrospective review of a sample of DME claims to determine compliance with regulations governing DME reimbursement, accurate and complete capture of DME services and documentary support for DME services claimed. Reviews can be performed for DME suppliers, physician practices, ASC's or Outpatient Hospital Departments. Focus includes both revenue optimization as well as prevention of overpayment. Particular focus is on key risk areas including:

• Compliance with, and documentary support for Regulatory Definition of "DME"
• Medical Necessity review and documentary support for such, including Physician Certification
• Review of compliance with Medicare "Repair/Replace/Maintenance" Regulations and documentary support for such
• Revenue Optimization focus includes compliance with regulations governing "upgraded items" , "customized items" and appropriate modifier utilization as well as documentary support for such.
• Review of correct DMERC vs Intermediary Billing
• Review of compliance with Medicare's "Beneficiary Permanent Residence" Requirement and documentary support for such
• Accurate HCPCS Coding of DME and documentary support for such
• Compliance with Medicare's "Rental to Purchase" Requirements and documentary support for such
• Compliance with regulations governing Provision of Medications in Conjunction with DME Supply Rules and documentary support for such
• Compliance with regulations governing Pre-Discharge Delivery of DME and documentary support for such
• Compliance with respect to reimbursement in complex DME areas is available including:

o Oxygen
o CPAP
o Insertable Loop Recorders
o Neuromuscular Stimulators
o Implantable Devices

"Operation Wheeler-Dealer" Legislation support

While a review of accurate and complete Diagnosis Coding is standard to all reviews, a focused review on diagnosis coding compliance and revenue optimization is available as an add-on or stand alone engagement.

Coding: per diem and "backlog" coding services are available by AAPC certified coders

Our Coding Helpline to answer coding/billing questions on demand is available with a 24 hour response time in most cases.

Documentation and Charge Capture Templates

A "Shadow Review service for Third Party Payer "Medical Claim Reviews" is available as an add-on or stand alone engagement.

Claim Denial, Suspend and Reduction reviews are available as well as preparation of Re-submissions and Payer Appeals

Litigation Support in Medicare fraud/abuse actions

Compliance with Medicare's ABN regulations is available as add-on or stand alone engagements.

HIPAA Compliance Reviews

Stark Law compliance reviews

Compliance Plan design, implementation & training; focus is on the OIG's Model Compliance Plans

Seminars on compliance, coding billing &documentations of DME services for clinical and non-clinical staff

Billing Seminars on DME services

"Update Seminarsare available; focusing on regulatory change

All seminars are available on videotape

Additional services available