BC Advantage - 2017 Issue 1

DME AUDITS ARE BACK! ARE YOUR CLAIMS COMPLIANT?

The number of durable medical equipment (DME) audits conducted by Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) have surged in recent years. Medicare contractors have gradually increased their scrutiny of DME suppliers' claims. This has resulted in increased post payment audits of DME suppliers' claims and associated overpayment demands made against DME suppliers. A previously unenforced standard is being enforced: DME suppliers are responsible for maintaining patient medical documentation that establishes the medical necessity for the DME item. In addition to the documents traditionally required to be maintained by DME suppliers: i.e., physician (or dispensing)...

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