WASHINGTON – CMS has officially approved five DMEPOS-related audit projects under the new Medicare Recovery Audit Contractor (RAC), Cotiviti GOV Services, according to a bulletin from AAHomecare.
The new projects include:
- Immunosuppressive drugs
- Medical necessity and documentation requirements – A complex review to determine if the submitted documentation supports Medicare’s coverage criteria and reasonable and necessary requirements.
- Home use of oxygen
- Medical necessity and documentation requirements – A complex review to determine if home oxygen meets coverage criteria and is medically reasonable and necessary.
- Durable medical equipment rentals
- Multiple billing within the same month – An automated review of overpayments associated to DMEPOS suppliers billing multiple rentals for the same equipment within the same month (27 days) will be recovered.
- Positive airway pressure devices for treatment of obstructive sleep apnea
- Medical necessity and documentation requirements – A complex review to determine if a PAP device is reasonable and necessary for the patient’s condition based on the documentation in the medical record.
- Ventilators
- Medical necessity and documentation requirements – A complex review to determine if ventilators meet coverage criteria and/or are medically reasonable and necessary.