Region 5 Resources
The latest alerts, updates and information for suppliers and providers in Region 5. (National US Contract)
News and Alerts for Region 5
Most Recent Update September 14, 2017
Effective 09/10/2017, The Centers for Medicare and Medicaid Services has issued a contractual guidance to the RACs regarding Hurricane Irma and its impact to the State of Florida (FL), the territory of the United States Virgin Islands, or the Commonwealth of Puerto Rico. The RAC’s will not send medical review additional documentation requests (ADR’s) to any providers in these affected areas for a period of 60 days starting on September 10, 2017. In addition, the RAC’s will not deny claims for providers which have been designated by the Federal Emergency Management Agency (FEMA) as eligible for direct federal assistance for a total of 60 days. Information by state and county is available on the FEMA Website at: Regarding Florida, per FEMA’s website, https://www.fema.gov/disasters.
Region 5 Resources
- Region 5 Approved Issues
- Performant Region 5 Outreach 2017 (download PDF here)
- Region 5 DME, Home Health, Hospice MACs (download PPT here)
- FAQs (download PDF here)
- Forms and Sample Documents (download PDFs here)
- Additional Documentation Submission Instructions (download PDF here)
- Discussion Request Form (download PDF here)
- Durable Medical Equipment (DME) Additional Documentation Limits
- Physician/Non-Physician Practitioner Additional Documentation Limits
- Noridian Solutions
- National Government Services (NGS)
- American Association Homecare
- National Association for Home Care & Hospice
- National Hospice and Palliative Care Organization
If you are a provider seeking additional information for Region 1 support, please click here
Ted Doyle is the Project Manager for the National Region 5 DMEPOS, Home Health, and Hospice Recovery Audit contract. Ted has over 32 years of experience in the healthcare industry with thorough knowledge of CMS Medicare and commercial healthcare coverage policies, procedures, and billing guidelines. Over his career he has been a senior leader with the CMS Program Integrity and Financial Management offices with Performant where he has been responsible for commercial clients' audit & investigation activities and also with multiple commercial healthcare insurers responsible for audit, investigations and analytics activities. Ted has over 20 years of experience serving as Project Manager with CMS and commercial healthcare insurers responsible for implementing and managing large scale service and systems delivery projects, conducting needs analysis, and developing and executing strategic plans. Overall, Ted is responsible to ensure the implementation of the National Region 5 RAC contract meets CMS requirements and development of a good working relationship with CMS, Providers, Industry associations and all interested parties and stakeholders.
Dr. Mary Pascucci
Contractor Medical Director - National Region 5
Dr. Mary Pascucci serves as Performant Recovery's Contractor Medical Director for the CMS National DMEPOS, Home Health and Hospice Contract. Her leadership, education and experience serves as a valuable asset to the medical review and concepts teams.
Prior to joining Performant, Dr. Pascucci acted as Performant's subcontracted Interim Medical Director. She was the Medical Director at Veritas MRS focused on the CMS Chronic Care Management program, DRG and InterQual review. Her role included physician-to-physician discussion, policy review, and ALJ interaction. Prior to Veritas, she was a Deputy Medical Director at the level of the QIC in charge of Physician Quality Control dealing primarily with DMEPOS, and also Part B Medicare. Dr. Pascucci's duties also included peer review for the VA System.
Dr. Pascucci has more than 20 years of experience as an Anatomic and Clinical Pathologist with experience as a Laboratory Medical Director at multiple hospital based as well as privately owned laboratories. She is board certified in both AP and CP. Dr. Pascucci holds an adjunct faculty position at the Geisinger Commonwealth School of Medicine. Dr. Pascucci received her degree from Philadelphia College of Osteopathic Medicine and did her residency at Geisinger Medical Center. She is currently enrolled at St. Joseph's University in the Executive Healthcare MBA program.