Audit Alerts from DME MAC Jurisdiction A

Posted on in Billing/Reimbursement

The van Halem Group reports that Noridian recently announced several service-specific prepayment reviews for suppliers billing to DME MAC Jurisdiction A. Please see the list below to determine if the services you provide to beneficiaries in Jurisdiction A could be at risk for an audit:

  • Enteral nutrition (HCPCS B4035)
  • Parenteral nutrition (HCPCS B4197, B4199)
  • Oxygen (HCPCS E0431, E1390)
  • Positive airway pressure (PAP) (HCPCS E0601)
  • Nebulizers (HCPCS J7605, J7626)
  • Pressure reducing support surfaces - Group 2 (HCPCS E0277)
  • Hospital beds (HCPCS E0260)
  • Ankle-foot/knee-ankle-foot orthosis (HCPCS L1970, L4360, L4361)
  • Spinal orthoses (HCPCS L0648, L0650)
  • Knee orthoses (HCPCS L1832, L1833)
  • Patient lifts (HCPCS E0630)
  • Manual wheelchairs (HCPCS K0001, K0003)
  • Therapeutic shoes for persons with diabetes (HCPCS A5500)
  • Immunosuppressive drugs (HCPCS J7507, J7517, J7518)
  • Urological supplies (HCPCS A4351, A4352, A4353)

For complete details on these reviews, refer to the Noridian DME MAC Region A website.

Jurisdiction A covers the following areas: Connecticut, Delaware, Massachusetts, Maine, Maryland, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont and Washington, D.C.