What’s New for DMEPOS - DME MAC Jurisdiction A

Below you will find a listing of current Medicare changes and updates to the DME MAC A Web site. Please join the DME MAC A ListServe to ensure that you receive notification of updates.

February | January | December | November

February

08 February 2010

PECOS Dear Physician Letter

05 February 2010

Medicare’s DMEPOS Competitive Bidding Program -A Better Way for Medicare to Pay for Medical Equipment (SE1007)
April 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (MM6804)
Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens (CR6806)
Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens (MM6806)
Surgical Dressings - Billing Update
Message of Interest to Physicians and Non-Physician Practitioners Regarding NPI and Enrollment Files (CMS Message 201001-29)
February is American Heart Month (CMS Message 201002-06)
”DR” condition code and the “CR” modifier on Medicare fee-for-service claims (CMS Message 201001-30)
Special Open Door Forum: Medicare Provider & Supplier Enrollment (CMS Message 201002-08)
The MLN Matters Special Edition Article #SE1007 - Medicare’s DMEPOS Competitive Bidding Program - A Better Way for Medicare to Pay for Medical Equipment - has just been released and is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1007.pdf. This article is informational for physicians, providers, and suppliers submitting claims to the Medicare Program and provides an overview of and the rationale for Medicare’s Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) being implemented by the Centers for Medicare & Medicaid Services (CMS). (CMS Message 201002-09)

04 February 2010

Results of Widespread Prepayment Review of Claims for HCPCS K0823, (Power Wheelchair, Group 2 Standard, Captain’s Chair, Capacity Up to and Including 300 Pounds)
LCD and Policy Article Revisions - Summary for February 4, 2010
Pneumatic Compression Devices - Article Retired
The following Local Coverage Determinations (LCDs) / Medical Policies have been revised:
- External Infusion Pumps (L5044)
- Facial Prostheses (L5046)
- Nebulizers (L11499)
- Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) (L5058)
- Spinal Orthosis: TLSO and LSO (L11470)

January

29 January 2010

Taking EDI to the Next Level - Fourth National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010 (CMS Message 201001-26)
Providers Randomly Selected to Participate in the Medicare Contractor Provider Satisfaction Survey (MCPSS) Urged to Respond (SE1005)
Remittance Advice (RA) Codes and Medicare Summary Notice (MSN) Messages Regarding Oxygen Equipment (CR6668)
Request from Redeterminations
1099-MISC Form Information
Utilizing the Interactive Voice Response System to Check for Same/Similar DMEPOS Items
Widespread Prepayment Probe for Oxygen and Oxygen Equipment LCD (L11486)
CERT Physician Letter - Nebulizers
CERT Physician Letter - Ostomy Supplies
CERT Physician Letter - Therapeutic Diabetic Shoes
The Centers for Medicare & Medicaid Services (CMS) has released a Special Edition MLN Matters article that reminds providers and suppliers that CMS has launched the fifth annual national administration of the Medicare Contractor Provider Satisfaction Survey (MCPSS). Providers and suppliers that have received a letter indicating that they were randomly selected to participate in the 2010 MCPSS are urged to take a few minutes to go online and complete this important survey via a secure Internet website. The article, SE1005 Providers Randomly Selected to Participate in the Medicare Contractor Provider Satisfaction Survey (MCPSS) Urged to Respond, is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1005.pdf on the CMS web site. (CMS Message 201001-23)
New and Updated Frequently Asked Questions (FAQs) are now available.
The following Online Tutorials have been updated:
- Commodes Billing (16 minutes)
- DME MAC Forms (15 minutes)
- Glucose Monitor Billing (30 minutes)
- Negative Pressure Wound Therapy Billing (24 minutes)
The article Guidance on Implementing System Edits for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (MM6566) has been revised.

28 January 2010

LCD and Policy Article Revisions - Summary for January 28 2010
Positive Airway Pressure (PAP) Devices LCD Revision - January 2010
The following Local Coverage Determinations (LCDs) / Medical Policies have been revised:
- Knee Orthoses (L27263)
- Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L11528)
- Power Mobility Devices (L21271)
- Wheelchair Options and Accessories (L11473)
- Wheelchair Seating (L15845)

22 January 2010

The article Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 276/277 Claim Status Second Phase (MM6721) has been revised.
UPDATE: Ordering/Referring Provider Front-End PECOS Warning Edits at the Common Electronic Data Interchange (CEDI) (CEDI Message)
LCD and Policy Article Revisions - Summary for January 2010
Automatic External Defibrillators - Coverage Reminder
The following Local Coverage Determinations (LCDs) / Medical Policies have been revised:
- Ankle-Foot/Knee-Ankle-Foot Orthosis (L11527)
- Ostomy Supplies (L11502)
- Surgical Dressings (L11471)
- Respiratory Assist Devices (L11504)
HOLD THE DATE - Program Advisory and Oversight Committee (PAOC) Update Meeting on Competitive Acquisition for DMEPOS (CMS Message 201001-19)
From the Medicare Learning Network - Did You Resolve To Learn Something New This Year? (CMS Message 201001-20)
New QUICK REFERENCE charts now available from the Medicare Learning Network (MLN) (CMS Message 201001-17)
The latest Claim Adjustment Reason Codes and Remittance Advice Remark Codes are available in the Codes.ini file for the MREP software. You can access this file in the Zipped folder for “Medicare Remit Easy Print - Version 2.7” at http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp on the CMS website. (CMS Message 201001-21)
World of Medicare NEW WBT course from the Medicare Learning Network (MLN) - Looking for help with the fundamentals of the Medicare Program? This NEW web-based training (WBT) course from the Medicare Learning Network (MLN) can help! The World of Medicare WBT is designed for health care professionals who want to understand the fundamentals of the Medicare Program. After completing this course, participants should be able to differentiate between Medicare Part A, Part B, Part C, and Part D, identify Medicare beneficiary health insurance options, eligibility, and enrollment, as well as recognizing how Medigap and Medicaid work with the Medicare Program. This WBT course offers continuing education credits, please see the course description for details. This training can be accessed by visiting http://www.cms.hhs.gov/MLNgeninfo/ and scrolling to the “Related Links Inside CMS” page section. Within these links, select Web Based Training (WBT) Modules and then World of Medicare (January 2010) from the list of trainings provided. (CMS Message 201001-18)
DME MAC CERT Education Task Force Survey: Your Feedback is Important! The DME MAC CERT Education Task Force conducted a national Ask-the-Contractor Teleconference (ACT) on January 13, 2010. As a result, the CERT Education Task Force is interested in the invaluable feedback from all attendees that participated in this national call. Please access the link below to complete a brief survey that will assist the CERT Education Task Force in making future improvements to CERT education initiatives. All comments will be reviewed by representatives from each DME MAC Jurisdiction. Survey link: http://www.surveymonkey.com/s/VH8CCSL

Note: Questions and answers as well as the encore presentation from the January 13, 2010 Ask-the-Contractor Teleconference (ACT) will be available on all DME MAC Jurisdiction Websites in the near future.

15 January 2010

Medically Unlikely Edits (MUEs) (CR6712)
The Medicare Learning Network Celebrates its 10th Anniversary (CMS Message 201001-11)
National Influenza Vaccination Week (CMS Message 201001-06)
The Q&A document for the December 16, 2009 Ask-the-Contractor Teleconference (ACT) has been posted.
The revised Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (Oct 2009), which offers general information about the Medicare Program, how to become a Medicare provider or supplier, Medicare payment policies, Medicare reimbursement, evaluation and management services, protecting the Medicare Trust Fund, inquiries, overpayments, and fee-for-service appeals, is now available in CD-ROM format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/ scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.” (CMS Message 201001-10)
The Adult Immunizations brochure, which provides an overview of Medicare's coverage of seasonal influenza, Pneumococcal, and Hepatitis B vaccines and their administration, is now available in print format. To place your order for the print version, select "MLN Product Ordering Page" in the "Related Links Inside CMS" Section on the Medicare Learning Network homepage at http://www.cms.hhs.gov/MLNGenInfo/01_Overview.asp . You can also view the downloadable version at the following address: http://www.cms.hhs.gov/MLNProducts/downloads/adult_immunization.pdf (CMS Message 201001-06)
CMS Launches Fifth Annual Medicare Contractor Provider Satisfaction Survey - The Centers for Medicare & Medicaid Services (CMS) is listening and wants to hear from you about your satisfaction with the services provided by Medicare fee-for-service (FFS) contractors that process and pay Medicare claims. CMS has launched the fifth annual Medicare Contractor Provider Satisfaction Survey (MCPSS). This survey offers Medicare FFS providers and suppliers an opportunity to give CMS feedback on their interactions with Medicare FFS contractors. Approximately 30,000 randomly selected providers will be notified in January that they have been selected to participate in the survey. CMS urges all health care providers selected to participate in the 2010 survey to take a few minutes to complete and return this important survey. To read the CMS press release announcing the launch of the 2010 MCPSS, please go to http://www.cms.hhs.gov/MCPSS/Downloads/2010_MCPSS_contractor_survey.pdf. CMS is listening and wants to hear from you. (CMS Messages 201001-04 and 201001-05)
Guidance on Implementing System Edits for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (MM6566)
Test Your Knowledge - The Orthotics & Prosthetics Quiz is Now Available

11 January 2010

Presentation Materials Now Available for January 13, 2010 Special Ask-The-Contractor Teleconference - The presentation materials are now available for the upcoming joint DME MAC Contractors Special Ask-the-Contractor Teleconference scheduled for January 13, 2010.

7 January 2010

The following Fee Schedules have been added:
   • 1st Quarter 2010 Jurisdiction A DME MAC Fee Schedule
   • 1st Quarter 2010 Average Sales Price Medicare Part B Drug Pricing File
   • 1st Quarter 2010 Oral Anticancer Drug Fees
New Place of Service (POS) Code for Walk-in Retail Health Clinic (MM6752)
Reminder: Express Plus Transitioning to PC-ACE Pro32 (CEDI Message)
CMS and ONC Issue Regulations Proposing a Definition of “Meaningful Use” and Setting Standards for Electronic Health Record Incentive Program (CMS Message 200912-34)
MLN Educational Products Related to Medicare-covered Preventive Services (CMS Message 200912-39)
January is National Glaucoma Awareness Month (CMS Message 201001-02)
CMS Launches Fifth Annual Medicare Health Care Provider Satisfaction Survey (CMS Medicare News)
CMS Issues Annual Report On National Health Spending (CMS Medicare News)
Standards and Certification Criteria to Support Meaningful Use of Electronic Health Records (Health Information Technology Updates)
Help Wanted: Skilled Health IT Workforce to Modernize Health Care (Health Information Technology Updates)
The written and audio transcript summaries of the ICD-10-CM/PCS Medicare Severity - Diagnosis Related Group Conversion Project National Provider Conference Call, which was conducted by the Centers for Medicare & Medicaid Services on November 19, 2009, are now available in the Downloads Section at http://www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp (CMS Message 201001-01)
The revised Understanding the Remittance Advice (RA) for Professional Providers Web-Based Training (WBT), has been made available by the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN). Available for Continuing Education credit, this course provides instructions to help fee-for-service Medicare providers and their billing staffs interpret the RA received from Medicare and reconcile it against submitted claims. It additionally provides guidance on how to read Electronic Remittance Advices (ERAs) and Standard Paper Remittance Advices (SPRs), as well as information for balancing an RA. This course also presents an overview of software that Medicare provides free to providers in order to view ERAs. This training can be accessed by visiting http://www.cms.hhs.gov/MLNgeninfo/ and scrolling to the “Related Links Inside CMS” page section. Within these links, select Web Based Training (WBT) Modules and then Understanding the Remittance Advice for Professional Providers from the list of training courses provided. (CMS Message 200912-38)
The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set. These changes have been posted to the HCPCS website at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp. Changes are effective on the date indicated on the update. (CMS Message 201001-03)
The Consolidated DME MAC A Supplier Manual is now available.

December

31 December 2009

The article Expiration of Medicare Processing of Certain Indian Health Service (IHS) Part B Claims - Sunset of Section 630 of the Medicare Modernization Act (MMA) of 2003 for Payment of Indian Health Services (IHS) (SE0912) has been replaced by MLN Article SE0930.
Sunset of Section 630 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 for the Payment of Indian Health Services (IHS) (SE0930)
Expiration of Various Payment Provisions Under the Medicare Program (SE0931)
CMS Processing Pharmacy DME Accreditation Determinations (CMS Message 200912-33)
DME MAC Jurisdiction A POE Advisory Group Openings for 2010
CMS Approved Audit Issues Posted for Region A Recovery Audit Contractor
HCPCS Code Update - 2010
An updated Non-Covered Item List is now available
January ACT Call Information Now available - DME MAC Contractors Introduce National CERT Education Initiative

24 December 2009

Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 276/277 Claim Status Second Phase (MM6721)
DME MAC Contractors Conduct Teleconference to Introduce National Comprehensive Error Rate Testing (CERT) Education Initiative
The Centers for Medicare and Medicaid Services (CMS) has posted the revised January 2010 ASP pricing file and crosswalk. All are available for download at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a19_2010aspfiles.asp
The Centers for Medicare & Medicaid Services (CMS) has posted the January 2010 ASP and Not Otherwise Classified (NOC) pricing files and crosswalks. The ASP pricing files for October 2009 and January 2009 have also been updated. All are available for download at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/ (see left menu for year-specific links). (CMS Message 200912-21)
New and Updated Frequently Asked Questions (FAQs) are now available

18 December 2009

Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update (MM6742)
The article Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers' Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs) (MM6421) has been revised)
The article Claim Status Category Code and Claim Status Code Update (MM6723) has been revised)
Documentation Reminder - Order Requirements
Bidder Alert For DMEPOS Competitive Bidding (CMS Message 200912-15)
The 2010 HCPCS Codes and Modifiers lists are now available
Are you wondering how to find the latest and greatest resources by subject? The REVISED Guided Pathways (NOV2009) booklets incorporate existing Medicare Learning Network (MLN) products and other centers resources into well organized sections that can help Medicare Fee-for-Service (FFS) providers and suppliers find information to understand and navigate the Medicare Program. These booklets guide learners to Medicare program resources, FFS policies and requirements. You can access the REVISED Guided Pathways (NOV2009) booklets at http://www.cms.hhs.gov/MLNEdWebGuide/30_Guided_Pathways.asp. on the Medicare Learning Network. (CMS Message 200912-12)

15 December 2009

DME MAC Jurisdiction A Resource Number 14 - December 2009 is now available
Meeting Minutes for the November 2009 Provider Outreach & Education Advisory Group Meeting are now available.

11 December 2009

CMS To Conduct Fifth Annual Medicare Contractor Provider Satisfaction Survey (CMS Message 200912-10)
REMINDER: Accreditation Time Frame for Pharmacies is January 1, 2010 (CMS Message 2009-12-03-002)
Providers Must Wait for Medicare Claim Crossover Process to Work (CMS Message 2009-12-07-003)
Beacon Communities: Shining a Light on the Real Impacts of Health IT (CMS Message 2009-12-07-002)
The newly redesigned MLN Products Catalog is now available and can be viewed at http://www.cms.hhs.gov/MLNGENINFO. The MLN Products Catalog is an interactive downloadable document that lists all Medicare Learning Network products by media format. The catalog has been revised to provide new customer-friendly links that are embedded within the document, as well as, both subject and provider type indexes. All product titles and the word "download" when selected, will link you to the online version of the product. The word "hard copy" when selected, will automatically link you to the MLN Product Ordering page. To access the catalog, click on the link MLN Product Catalog. (CMS Message 2009-12-07-001)
Do you ever wonder about how to utilize search tools in selected areas of the CMS web site? The searchable Medicare Coverage Database (MCD) contains all Medicare National Coverage Determinations (NCDs), National Coverage Analyses (NCAs), Local Coverage Determinations (LCDs), and local policy articles. The Medicare Learning Network (MLN) has produced a “How To” booklet (2.5 MB), that provides an explanation of the MCD, as well as how to use the Search, Indexes, Reports and Downloads features. The How to Use the Medicare Coverage Database booklet (November 2009) can be located at http://www.cms.hhs.gov/MLNProducts/MPUB/list.asp. on the MLN Publications page. Use search key words “how to” to locate this publication quickly. Understanding the search tool is the best way to find the information for which you are looking! (CMS Message 2009-12-03-001)
New and Updated Frequently Asked Questions (FAQs) are now available

04 December 2009

Annual Update of HCPCS Codes Used for Home Health (HH) Consolidated Billing Enforcement (MM6662)
The article Therapy Cap Values for Calendar Year (CY) 2010 (MM6660) has been revised
Billing Reminder: Submitting Claims for DME Replacement Items Broken Beyond Repair
Fax Submission Tips and Reminders
Overpayments - Frequently Asked Questions
Reminder: Bidding is now Open for the Round 1 Rebid of the DMEPOS Competitive Bidding Program (CMS Message 200911-37)
The Cancer Screenings brochure, which provides information about Medicare coverage of screening mammographies, screening pap tests, screening pelvic exams, and colorectal and prostate cancer screenings, is now available in print format. To place your order for the print version, select "MLN Product Ordering Page" in the "Related Links Inside CMS" Section on the Medicare Learning Network homepage at http://www.cms.hhs.gov/MLNGenInfo/01_Overview.asp. You can also view the downloadable version at the following address: http://www.cms.hhs.gov/MLNProducts/downloads/cancer_screening.pdf (CMS Message 2009-11-23)
The Smoking and Tobacco-Use Cessation Counseling Services brochure, which provides information about Medicare coverage of smoking and tobacco-use cessation services, is now available in print format. To place your order for the print version, select "MLN Product Ordering Page" in the "Related Links Inside CMS" Section on the Medicare Learning Network homepage at http://www.cms.hhs.gov/MLNGenInfo/01_Overview.asp. You can also view the downloadable version at the following address: http://www.cms.hhs.gov/MLNProducts/downloads/smoking.pdf (CMS Message 2009-11-23)