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Audit (A-09-12-02053)

MedEnvios Healthcare, Inc., Submitted Claims for Diabetic Testing Supplies Without the KL Modifier in Accordance With Medicare Billing Requirements

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For calendar year 2011, MedEnvios Healthcare, Inc. (Medenvios), submitted claims for diabetic testing supplies without the KL modifier in accordance with Medicare billing requirements. Beneficiaries may obtain diabetic testing supplies from a walk-in supplier or a mail-order supplier, which delivers the supplies through a common carrier. Suppliers must use the KL modifier on all claims for mail-order diabetic testing supplies.

All 100 sampled line items were properly submitted without the KL modifier because Medenvios used company-owned vehicles to deliver diabetic testing supplies to Medicare beneficiaries at their homes. Under Medicare requirements in effect until CMS implements the revised definition of a mail order item, supplies delivered by company-owned vehicles are not considered mail-order items. Therefore, claims for these supplies do not require use of the KL modifier. Consequently, this report has no recommendations.

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