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Medical Coding News Archives

CMS TOUGHENS REVIEWS—SUSPENDS PAYMENTS

 
January 12, 2010:

In an ongoing effort to reduce waste, fraud, and abuse, the Centers for Medicare and Medicaid Services (CMS) is requiring certain durable medical equipment suppliers to post a surety bond and has revoked the billing privileges of more than 1,100 medical equipment suppliers in south Florida and southern California.

The agency has also suspended payments to some Dade County Florida home health suppliers and is implementing extensive pre- and post-payment review of claims submitted by referring physicians. 

The Balanced Budget Act of 1997 initiated surety bond regulations that require suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) to post a $50,000 surety bond. Existing suppliers must comply with this requirement by Oct. 2, 2009, while newly enrolling suppliers have only until May 4, 2009. CMS indicates that the surety bond is required, in part, because of a large number of improper and potentially fraudulent payments to medical equipment suppliers for furnishing medical equipment and devices to people with Medicare.

The intense scrutiny of home health claims also includes: 

  • Using follow-up letters to validate claims submitted by physicians who order a high number of certain items or services
  • Verifying the relationship between physicians who order a large number of home health services and the beneficiaries for whom they ordered those services
  • Identifying and visiting high-risk beneficiaries to ensure they are appropriately receiving the services for which Medicare is being billed

Deborah C. Hall
Clinical/Technical Editor

 

 
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