The Department of Health and Human Services Office of Inspector General recently released a report stating Noridian, a jurisdiction D durable medical equipment Medicare administrative contractor, did not meet the coverage requirement in local coverage determination requirements for lower limb prosthetic claims.
Titled “Durable Medical Equipment Claims Paid by Noridian Healthcare Solutions, LLC, Did Not Always Meet the Requirements of the Local Coverage Determination for Lower Limb Prostheses”, the OIG report said Noridian paid $89,762 for 41 lines of service that had a missing or incorrect function level modifier code. Noridian also processed and paid $6,747 for seven lines of service that had unallowable combinations of components.
OIG recommended that Noridian recover the $96,509 in identified overpayments for lines of service for lower limb prostheses that did not meet local coverage determination (LCD) requirements, as well as continue to monitor the edits developed and updated in response to CMS’s March 2012 Technical Direction Letter, which directed durable medical equipment Medicare administrative contractors to develop claim-processing edits for all requirements in LCDs for lower limb prostheses, to ensure that the edits are functioning correctly.
For more information:
Durable Medical Equipment Claims Paid by Noridian Healthcare Solutions, LLC, Did Not Always Meet the Requirements of the Local Coverage Determination for Lower Limb Prostheses. Available at: http://oig.hhs.gov/oas/reports/region7/71205035.pdf. Accessed Sept. 19, 2013.