Home Health & Hospice Week

Another OIG report is projecting millions in Medicare overpayments for DME billed with the KX modifier. Background: In 2006, DME regional contractors Palmetto GBA and CIGNA overpaid such claims by about $127 million, the OIG estimated based on a 100-claim sample. The KX modifier indicates that the item in question has extra documentation requirements and that the supplier has the required documentation on file. Now the OIG says DMERC NHIC overpaid KX modifier claims for DME by about $54 million in 2007, says a new report at www.oig.hhs.gov/oas/reports/region1/10900528.pdf. The missing documentation included proof of delivery, physicians' orders, use or compliant use follow-up documentation, sleep studies, and physicians' statements, the report says. NHIC agreed that it should review claims for these problems and recover unallowable payments, notify CMS of 24 suppliers who did not meet the supplier standard for maintaining proof of delivery so that CMS can take appropriate action, [...]