Unfortunately, regulatory threats and issues are real and can put your business in serious jeopardy.
As a U.S. Rehab member, you will benefit from our team of reimbursement specialists and regulatory experts to keep you updated on new regulations and compliance issues for the DMEPOS industry, competitive bidding, HIPAA, accreditation and other areas.
Our team are not only expert researchers, but also regularly attend industry events. They give you the knowledge and tools you need so that you aren’t facing any regulatory pressure on your own.
Sign up for U.S. Rehab's reimbursement updates via text and never miss an important update again!
Do you get a lot of email messages regarding reimbursement information? So many that you don't have time to determine which ones are important and which ones are really important? If you miss a truly important update, it can be very detrimental to your business and cost you thousands of dollars in reimbursement. U.S. Rehab has an answer! We've signed up for an EZ Texting program that enables us to send U.S. Rehab members reimbursement updates via text directly to your cell phone. These text messages will contain a brief message of the update with an attachment or a link for details.
Click here for more information!
Important Reminders for Reimbursement Updates
1. No KH On Purchased Capped Rentals Beginning October 1, 2018
2. Power Mobility Device (PMD) Prior Authorization Extended And Expanded Nationally As Of Sept. 1, 2018
3. Sign Up For Reimbursement Updates Via Text Message
For more information regarding these updates, please click here.
Power Wheelchair Prior Authorization - Update
CMS has selected 31 items of durable medical equipment (K0813-K0855) to be subject to required prior authorization beginning NATIONWIDE on Sept. 1, 2018.
All new rental series claims (K0813-K0831) for these PMDs with a date of delivery on or after Sept. 1, 2018, must be associated with a prior authorization request as a condition of payment. Those that have the purchase option (K0835-K0855) will also require a prior authorization as a condition of payment. Click here for more information!
The KE Modifier is Back (Temporarily)!
June 5, 2018
The KE modifier is BACK temporarily!
The DME MACs published the following article on May 31, 2018 regarding the KE modifier. If you provide manual wheelchairs to Medicare beneficiaries that reside in a rural area, then please continue reading.
If you provide an affected accessory on a manual wheelchair base (K0001-K0009 and E1161) to a Medicare beneficiary who resides in a rural area (based on zip code) and the date of service is from June 1, 2018 – Dec 31, 2018, then you should append the KE modifier on those accessories. The purpose of the KE modifier is to receive the highest reimbursement possible for those accessories.
Click here for more details.
Power Mobility Device (PMD) Prior Authorization Extended and Expanded Nationally!
June 4, 2018
The PMD Prior Authorization Demo program was established in 2012 in seven states and was expanded to an additional 12 states in Oct 2014. This demo program was slated to end on Aug 31, 2018, however, prior authorization for certain PMDs will continue and be expanded nationally beginning Sept 1, 2018 as a Condition of Payment.
Click here to learn more details about the extension here.
March 14, 2018
The revalidation reminder link is available for suppliers to check if their revalidation is due this year. REMEMBER that the National Supplier Clearinghouse (NSC) will send you a letter prior to the due date. Do not submit any information until you receive the letter.
Click here for more information.
CGS Update: Custom Cushion and Backs REVERT BACK to Individual Pricing!
May 23, 2017
In April of 2017, DME MACs B and C (GCS) decided to establish a fee for the custom cushion and back codes (E2609 and E2617, respectively) without notifying the provider community. Because these items are custom (misc.), they were manually priced under individual consideration prior to this change. The fees they established were a significant reduction (60 percent lower) than previously priced claims.
The CRT industry strongly voiced concern with this change, and as a result, CGS has decided to revert back to individual consideration pricing for these codes! Read more.