August 7, 2009
Suppliers often create forms to facilitate gathering medical necessity information and ordering durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), calling them “Certificates of Medical Necessity.” While supplier-created forms are generally not prohibited, suppliers must also recognize that a Certificate of Medical Necessity (CMN) is a specific Medicare term that describes an Office of Management and Budget (OMB)-approved form created by the Centers for Medicare and Medicaid Services (CMS). CMS is required to review and update the forms on a periodic basis and receive approval from the OMB in order to continue their use.
Only OMB-approved, active CMNs that are in use for the date of service on the claim under consideration for reimbursement will be recognized by CIGNA Government Services (CGS) in support of medical need or, when completed properly, as a substitute for a written order. Use of inactive or “retired” CMNs will not be recognized by CGS for either medical necessity purposes or as a substitute for a written order.
August 3, 2009
In a list-serv message this afternoon, the Centers for Medicare & Medicaid Services announced the following timeline for the Round 1 rebid of Medicare’s DMEPOS competitive bidding program:
The Centers for Medicare & Medicaid Services (CMS) announces timeline/schedule of education events, begins bidder education campaign
Registration for user IDs and passwords begins.
Last day for DMEPOS suppliers to get accredited
DMEPOS supplier surety bond deadline
CMS opens 60-day bid window for Round 1 Rebid
Covered Document Review Date for bidders to submit financial documents
60-day bid window closes
CMS announces single payment amounts, begins contracting process
CMS announces contract suppliers, begins contract supplier education campaign
Early Fall 2010
CMS begins supplier, referral agent, and beneficiary education campaign
New program begins!
July 20, 2009
CIGNA Government Services, the Jurisdiction C DME MAC, will be implementing a service-specific prepayment edit for Healthcare Common Procedure Coding System (HCPCS) code K0823 (Power wheelchair, Group 2 standard, captains chair, patient weight capacity up to and including 300 pounds). This edit is the result of data demonstrating a high claims payment error rate for this power wheelchair product category.
Claims subjected to this edit will be developed for additional documentation. Suppliers receiving a development letter should follow the instructions contained in the letter for the specific documentation requested. Suppliers will be asked to submit documentation including, but not limited to:
- Physician’s Order
- Detailed Product Description
- In-home Assessment
- Documentation of Face-to-Face Evaluation
- Medical Record Documentation of Medical Necessity
- Proof of Delivery and Product Information
The information must be received within 30 days of the date of the letter or the claim will be denied.
Suppliers are reminded that medical necessity documentation (e.g., notes from prior visits, test reports, etc.) must be obtained from the treating physician to provide a historical perspective that reflects the patient’s condition in the continuum of care, corroborating the information in the face-to-face examination, painting a picture of the patient’s condition and progression of disease over time.
Additional information on this and other documentation requirements for code K0823 may be found on the CGS Medical Review web site at:
July 17, 2009
Courtesy of the Texas Alliance of Home Care Services (TAHCS)
The NSC (National Supplier Clearing House) is calling suppliers to make sure they answer the phone during business hours.
If you fail to answer your telephone or if it is rerouted to voice mail after three (3) tries, a representative indicated to TAHCS, they will revoke your NSC number.
If revocation occurs you may be required to re-apply and go back through the entire process.
TAHCS recommends you alert your staff to be prompt on answering the phone
and note: if you have caller ID it shows “Out of Area”.
Be sure to ask the representative to verify your supplier number, your date of birth and social security number or other information to prove it is the NSC calling.
Obtain the NSC representative’s name & number and call them the next day for further verification.
DO NOT GIVE THE CALLER ANY INFORMATION BEFORE
THEY VALIDATE THEIR STATUS AS AN NSC Representative
July 17, 2009
CMS Acting Administrator Charlene Frizzera invites you to a special Webinar with the Centers for Medicare & Medicaid Services on the Competitive Bidding Round I Rebid for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
The Medicare DMEPOS Competitive Bidding Program Round I Rebid Is Coming Soon!! Medicare’s DMEPOS competitive bidding program will change the way some beneficiaries obtain certain medical equipment and supplies.
An educational Webinar for DMEPOS referral agents (beneficiary advocacy groups and prescribers) will be held on July 20, 2009.
Participants will have the opportunity to ask questions of CMS policy experts.
July 20, 2009 2 p.m., eastern time
Click here to register for the CMS Webinar https://www.fedmeetings.net/common/registration.cfm?mid=2497
July 15, 2009
American’s Affordable Health Choices Act (H.R. 3200), includes the following changes that will affect the HME/Pharmacy provider:
- Requires the oxygen supplier in month 27 of the 36-month rental period to continue to supply oxygen during the period of medical need through the end of the useful lifetime, regardless of the patient’s location, unless another supplier accepts responsibility for the patient. The bill makes this provision effective on the date of enactment of the bill.
- Restores a new 36-month rental period for patients in the case that the supplier is declared bankrupt and its assets are liquidated. The patient must have at least 24 months of rental payments to qualify for a new rental period.
- The First Month Purchase Option for Standard Power Wheelchairs will be removed.
- Waives the surety bond requirement for pharmacies that have had a DME supplier number for at least 5 years and have never had a final adverse action imposed.
- Exempts pharmacies that supply diabetic testing supplies, canes, and crutches from DME accreditation.
- Any supplier that has submitted an application for accreditation before August 1, 2009, shall be deemed as meeting applicable standards and accreditation requirement under this subparagraph until such time as the independent accreditation organization takes action on the supplier’s application.