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Andrea Stark

CMS ready to roll with prior authorizations


BALTIMORE – CMS is moving forward with its plans to implement a prior authorization process for certain DME and stakeholders say it should make life easier for providers.

Did you catch this change to payments for nutrition?


A  new enforcement of quantity details on detailed written orders for enteral nutrition is manifesting in claim denials.

New national RAC for HME?


YARMOUTH, Maine – A tug of war between CMS and the RACs over planned changes to contingency fees could lead to a new national RAC for HME, says Andrea Stark.

We have the answer to this $64 million question

Monday, February 2, 2015

Do you want to know what the regional pricing might look like under the national rollout of competitive bidding scheduled to take place Jan. 1, 2016?

Andrea Stark, a reimbursement consultant with MiraVista, can give you a pretty good idea.

WOPD requirement still problematic


WASHINGTON – CMS has been enforcing the written order prior to delivery (WOPD) requirement for a year now, but compliance is still a road filled with potholes for many HME providers, industry stakeholders say.

Face-to-face rule: Clarifications provide ‘breathing room’


WASHINGTON – Recent clarifications from CMS and its contractors have loosened the noose that is the face-to-face requirement, industry stakeholders say.

RACs are back


WASHINGTON – CMS announced last week that the recovery audit contractors (RACs) will restart some of their reviews, but industry stakeholders don’t expect any curveballs.

Unbundling trips up providers


YARMOUTH, Maine – Provider Brent Bradshaw says Round 2 of competitive bidding has sparked a disturbing trend: contract suppliers billing patients for brake attachments for walkers that CMS has already paid for.

Take PECOS seriously, stakeholders say


WASHINGTON – CMS has set a new start date for denying DME claims with the names of physicians who are not enrolled in PECOS and, this time, it may stick, industry stakeholders say.