Use of inactive or “retired” CMNs will not be recognized by Cigna for either medical necessity purposes or as a substitute for a written order

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.

CMS Sets Timeline for Round 1 Rebid

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

June 2010
CMS announces single payment amounts, begins contracting process

September 2010
CMS announces contract suppliers, begins contract supplier education campaign

Early Fall 2010
CMS begins supplier, referral agent, and beneficiary education campaign

New program begins!

HCPCS Code K0823 – Service Specific Pre-Pay Review

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
 The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Round 1 Rebid is coming soon!!
Summer 2009
–  CMS announces bidding schedule/schedule of education events
–  CMS begins bidder education campaign
–  Bidder registration period to obtain user ID and passwords begins
Fall 2009
–  Bidding begins
If you are a supplier interested in bidding, prepare now – don’t wait!
–  UPDATE YOUR NSC FILES:  DMEPOS supplier standard # 2 requires ALL suppliers to notify the National Supplier Clearinghouse (NSC) of any change to the information provided on the Medicare enrollment application (CMS-855S) within 30 days of the change. DMEPOS suppliers should use the 3/09 version of the CMS-855S and should review and update:
     –  The list of products and services found in section 2.D;
     –  The Authorized Official(s) information in sections 6A and 15; and
     –  The correspondence address in section 2A2 of the CMS-855S. 
This is especially important for suppliers who will be involved in the Medicare DMEPOS Competitive Bidding Program. These suppliers must ensure the information listed on their supplier files is accurate to enable participation in this program. Information and instructions on how to submit a change of information may be found on the NSC website ( and by following this path: Supplier Enrollment/Change of Information/Change of Information Guide.  
–  GET LICENSED: Suppliers submitting a bid for a product category in a competitive bidding area (CBA) must meet all DMEPOS state licensure requirements and other applicable state licensure requirements, if any, for that product category for every state in that CBA. Prior to submitting a bid for a CBA and product category, the supplier must have a copy of the applicable state licenses on file with the NSC. As part of the bid evaluation, we will verify with the NSC that the supplier has on file a copy of all applicable required state license(s).
–  GET ACCREDITED: CMS would like to remind DMEPOS suppliers that time is running out to obtain accreditation by the September 30, 2009, deadline or risk having their Medicare Part B billing privileges revoked on October 1, 2009. Accreditation takes an average of six months to complete. DMEPOS suppliers should contact a CMS deemed accreditation organization to obtain information about the accreditation process and the application process.  Suppliers must be accredited for a product category in order to submit a bid for that product category. CMS cannot contract with suppliers that are not accredited by a CMS-approved accreditation organization. 
Further information on the DMEPOS accreditation requirements along with a list of the accreditation organizations and those professionals and other persons exempted from accreditation may be found at the CMS website:
–  GET BONDEDCMS would like to remind DMEPOS suppliers that certain suppliers will need to obtain and submit a surety bond by the October 2, 2009, deadline or risk having their Medicare Part B billing privileges revoked. Suppliers subject to the bonding requirement must be bonded in order to bid in the DMEPOS Competitive Bidding Program. A list of sureties from which a bond can be secured is found at the Department of the Treasury’s “List of Certified (Surety Bond) Companies;” the website is located at:
Visit or the CMS website at for the latest information on the DMEPOS Competitive Bidding Program.

NSC: Answer your phone or lose your supplier number

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.

CMS Webinar for DMEPOS Competitive Bidding Program Coming Soon!!

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


New changes to the Health Reform Bill (HR 3200)

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.

VGM Competitive Bidding Seminars – Register NOW

July 13, 2009