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David McGill Blogger

National RAC Kicking Off Audit Activity

Posted by David McGill | March 14, 2017

​​Yesterday the DME MACs announced that CMS has granted approval to Performant Recovery to begin auditing DMEPOS claims. Performant is the new national (Region 5) auditor for claims of this type. Here's what you need to know:

  • The list of Issues Under Review on Performant's website does not currently specify any that are specific to orthotic or prosthetic claims.
  • The listed issues relate primarily to DME: catheters; chest wall oscillation devices; bone stim devices; support services; nebulizers; CPM devices; and DME billed while the beneficiary is in an inpatient facility (48-hour rule compliance).

What does this mean for you?

The list of current Issues Under Review suggests that orthotic and prosthetic claims may not be an initial area of primary focus for Performant. The one issue that could potentially implicate O&P is the 48-hour rule item. However, given the fact that Performant is just kicking off its audit activities, it is possible that we could see an expansion of the listed issues in the coming weeks and months.​

We will continue to monitor Performant's activity and provide you any updates as new information becomes available.

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