The National Government Services Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Review Department has announced that it will be initiating a widespread prepayment medical review of high dollar durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims. A widespread prepayment medical review is a selection of paid claims reviewed for medical necessity based on a particular service from multiple suppliers.
Suppliers of the selected claims will be mailed a letter to the correspondence address on file requesting documentation to support the medical necessity for the items billed. National Government Services has recommended that suppliers review several resources in order to determine all records are collected and sent within a timely manner. Some of the resources suppliers should refer can be found on the National Government Services website.
- The “Standard Documentation Language for Local Coverage Determinations” article posted on March 12, under the news articles Quick Links.
- The local coverage determinations and related policy articles for items that are billed by suppliers, which can be found under Medical Policy Center (LCDs) Quick Links.
- Chapter 8 of the Jurisdiction B DME MAC Supplier Manual Quick Links.
- The Clinical Education section of the National Government Services website to review additional information for medical policies.
Suppliers who receive a notification letter must respond with all documentation within the timeframe published on the letter.
