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What's New for DME

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.

May

11 May 2012

• New Physician Specialty Code for Sleep Medicine and Sports Medicine (MM7600)
• Spotlight Women’s Health in May in Recognition of Women’s Health Week, and Women’s Checkup Day (CMS Message 201205-13)
• Medicare Enrollment/Revalidation: Requests for the IRS Form CP 575 (CMS Message 201205-28)
• Were You Sent a Request to Revalidate Your Medicare Enrollment? (CMS Message 201205-29)
• Results of Widespread Prepayment Review for B9000 (Enteral Nutrition Infusion Pump-Without Alarm) and B9002 (Enteral Nutrition Infusion Pump-With Alarm) (L5041)
• Correct Billing for Upper Limb Prosthesis with L6895 instead of L7499
• LCD and Policy Article Revisions Summary for May 2012
• Concentric Adjustable Torsion Joints - Correct Coding
• Glucose Monitors - Policy Revision Summary
• The following Local Coverage Determinations (LCDs) / Medical Policies have been revised:
  • Ankle-Foot/Knee-Ankle-Foot Orthosis
  • External Breast Prostheses
  • Glucose Monitors
  • Knee Orthoses
  • Manual Wheelchair Bases
  • Mechanical In-exsufflation Devices
• The MLN Product Featured this month is the Medicare Fraud & Abuse: Prevention, Detection, and Reporting booklet
• The VPIQ Enrollment Form has been revised
• DMEPOS Suppliers Can Easily Update Authorized Official and Ownership Information Using Medicare’s Online Enrollment System - Has there been a change in your Authorized Official (AO) or entity which owns 5% or more of your organization? Since February 11, 2012, it’s been easy to update the information on file with Medicare using Medicare’s online enrollment system (PECOS). PECOS is pre-populated with current AO and ownership information. When viewing the Individual and Organization control topic sections, you can modify or delete the pre-populated individual and organization control data and changes will be reflected across all enrollment applications for your Provider or Supplier and Tax Identification Number. (CMS Message 201205-17)
• Submit Your Medicare Enrollment Application Up to 60 Days Before the Effective Date - Providers and suppliers can now submit their enrollment applications 30 days sooner. CMS-855 enrollment applications and Internet-based PECOS applications may now be submitted 60 days prior to the effective date. (NOTE: This does not apply to providers and suppliers submitting a Form CMS-855A application, Ambulatory Surgical Centers (ASCs), or Portable X-ray Suppliers (PXRSs).) (CMS Message 201205-30)

04 May 2012

• Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2012 Update (MM7831)
• Modification to CWF, FISS, MCS and VMS to Return Submitted Information When There is a CWF Name and HIC Number Mismatch (MM7260)
• Overpayment Recovery from Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (MM7744)
• Major Improvements to Medicare Online Enrollment System (CMS Message 201204-56)
• DME MAC Jurisdiction A IVR Enhancements
• January 2012 CERT Errors
• February 2012 CERT Errors
• Meeting Minutes for the March 2012 Provider Outreach & Education Advisory Group Meeting are now available
• “Medicare Quarterly Provider Compliance Newsletter [Volume 2, Issue 3]” Released - The “Medicare Quarterly Provider Compliance Newsletter [Volume 2, Issue 3]”, Educational Tool (ICN 907927) has been released and is now available in downloadable format. This educational tool is designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program. It highlights the top issues of the particular Quarter. Please visit the Medicare Quarterly Provider Compliance Newsletter Archive to download, print, and search an archive of previously-issued newsletters.
• Slides and Comments from the WEDI-CMS Industry Collaboration and Problem Solving Webinar are Now Posted (CMS Message 201205-03)
• Providers who Receive Error Codes H20203 and H45255 Need to Balance Bill (CMS Message 201205-08)

April

27 April 2012

• Results of Widespread Prepayment Review for Home Blood Glucose Monitor Supplies (HCPCS Codes A4253 (BLOOD GLUCOSE TEST OR REAGENT STRIPS FOR HOME BLOOD GLUCOSE MONITOR, PER 50 STRIPS) and A4259 (LANCETS, PER BOX OF 100) (LCD L11530)
• A new DMEPOS Express Podcast - Standard Documentation Language for Local Coverage Determinations has been posted.
• “Guidance for Correct Claims Submission When Secondary Payers Are Involved” MLN Matters® Article Released - MLN Matters® Special Edition Article #SE1217, “Guidance for Correct Claims Submission When Secondary Payers Are Involved” has been released and is now available in downloadable format. This article is designed to provide education on how providers and suppliers should correctly submit claims associated with a Medicare Secondary Payer (MSP). It includes guidance and tools that providers, physicians, and other suppliers can use to ensure MSP information is captured at the time of billing, so that the appropriate primary payer is billed before Medicare, as required by law.
• New Fast Fact on MLN Provider Compliance Webpage - A new fast fact is now available on the MLN Provider Compliance webpage. This webpage provides the latest Medicare Learning Network® (MLN) products designed to help Medicare Fee-For-Service providers understand and avoid common billing errors and other improper activities. Please bookmark this page and check back often as a new fast fact is added each month.
• Test Your Knowledge - The Enteral Quiz is Now Available
• Health Care Law Protects Against Fraud, Saves Nearly $1.6 Billion (CMS Message 201204-45)
• Medicare Stable, But Requires Strengthening (CMS Message 201204-46)
• Complete Signing Your Medicare Enrollment Application Electronically (CMS Message 201204-48)
• The 30-Day Comment Period is Now Open for the HHS Proposed Rule to Delay ICD-10 (CMS Message 201204-50)

24 April 2012

• The article Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs) (MM6417) has been revised
• The DME MAC A IVR User Guide and Call Flow have been revised
• The Q&A document for the March 27, 2012 ACT Call has been posted

20 April 2012

• Claim Status Category and Claim Status Codes Update (MM7793)
• DMEPOS Competitive Bidding Round 1 Recompete Announced (CMS Message 201204-28)
• Agendas for Upcoming HCPCS Public Meetings Now Available - Tues May 8 and Wed May 9 (CMS Message 201204-24)
• April is National Cancer Control Month (CMS Message 201204-29)
• New Report: Competitive Bidding Saving Money For Taxpayers And People With Medicare (CMS Press Release April 18, 2012)
• Results of Widespread Prepayment Complex Review for Lower Limb Prostheses
• Results of Widespread Prepayment Review for E0570 (Nebulizer, with Compressor) (L11499)
• 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)
• Results of Widespread Prepayment Review of Claims for HCPCS E0601, (Continuous Positive Airway Pressure Devices)
• The DME MAC A Web site Navigation Guide has been revised.
• “Information on the CMS Fraud Prevention: Automated Provider Screening and National Site Visit Initiatives” MLN Matters® Article Released - MLN Matters® Special Edition Article #SE1211 , “Information on the Centers for Medicare & Medicaid Services (CMS) Fraud Prevention: Automated Provider Screening and National Site Visit Initiatives” has been released and is now available in downloadable format. This article is designed to provide education on the CMS National Fraud Prevention Program (NFPP) and processes used to prevent Medicare fraud and abuse. It includes information about two new initiatives that CMS uses as part of the provider enrollment process - automated provider screenings and national site visit contractors that conduct site visits for certain providers and suppliers.
• “Redesigned Medicare Summary Notices” MLN Matters® Article Released - MLN Matters® Special Edition Article #SE1218 , “Redesigned Medicare Summary Notices” has been released and is now available in downloadable format. This article is designed to provide education on the redesigned Medicare Summary Notice (MSN), which is part of the “Your Medicare Information: Clearer, Simpler, At Your Fingerprints” initiative. It includes information about key features and enhancements to the redesigned MSN and steps CMS will take to make benefits, provider, and claims information clearer and more accessible.
• Submit Feedback on MLN Products and Services - The Medicare Learning Network® (MLN) is interested in what you have to say! Visit the MLN Opinion Page to submit an anonymous evaluation about specific MLN products and resources. Your feedback is important in developing and improving future MLN products and services.

13 April 2012

• July 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (MM7810)
• Redesigned Medicare Summary Notices (SE1218)
• Information on the Centers for Medicare & Medicaid Services (CMS) Fraud Prevention: Automated Provider Screening and National Site Visit Initiatives (SE1211)
• Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), Medicare Remit Easy Print (MREP), and PC Print Update (MM7775)
• Guidance for Correct Claims Submission When Secondary Payers Are Involved (SE1217)
• The article Pharmacy Billing for Drugs Provided "Incident To" a Physician Service (MM7397) has been revised
• HHS and Department of Justice Highlight Health Reform Tools to Combat Medicare Fraud (CMS Message 201204-10)
• HHS Secretary Sebelius's Statement on National Minority Health Month (CMS Message 201204-01)
• New Health Care Law Provisions Cut Red Tape, Save up to $4.6 Billion (CMS Message 201204-19)
• Take a Look at the Version 5010 FAQs and View CMS' Version 5010 Page and Resources (CMS Message 201204-20)
• New Affordable Care Act program to Improve Care, Control Medicare Costs, Off to a Strong Start (CMS Message 201204-22)
• April is Alcohol Awareness Month (CMS Message 201204-23)
• The MLN Product Featured this month is the Items and Services That Are Not Covered Under the Medicare Program booklet
• "DMEPOS Quality Standards" Booklet Revised - The "DMEPOS Quality Standards" booklet (ICN 905709) has been revised and is now available in downloadable format. It is designed to provide education on durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and includes DMEPOS quality standards as well as information on Medicare-deemed Accreditation Organizations for DMEPOS suppliers.
• "Medicare Vision Services" Fact Sheet Now Available - The "Medicare Vision Services" fact sheet (ICN 907165) has been released and is now available in both downloadable and hardcopy formats. This fact sheet is designed to provide education on Medicare coverage and billing information for vision services, and includes specific information concerning coding requirements and an overview of coverage guidelines and exclusions. To order hardcopies of this fact sheet, visit http://www.cms.gov/MLNProducts and click on 'MLN Product Ordering Page' under 'Related Links Inside CMS' at the bottom of the webpage.
• CMS.gov Website Upgrade Completed - Check your Bookmarks - CMS has completed the upgrades to the http://www.CMS.gov website. Bookmarked links to items posted in the "Downloads" sections on the CMS website have not been affected, but other bookmarked URLs are redirected to the index webpage for that topic. For example, if you bookmarked the page containing National Provider Calls and Events, you will be taken to the index page for National Provider Calls. On the index page, select the webpage you'd like to view from the left-hand side. Once you open the correct page, you can create a new bookmark. We appreciate your understanding and apologize for any inconvenience during this process. (CMS Message 201204-16)

06 April 2012

• 2012 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction (MM7679)
• Sign Your Medicare Enrollment Application Electronically (CMS Message 201203-64)
• ICD-10: It’s Closer Than It Seems - Have You Completed Your 5010 Implementation? (CMS Message 201203-60)
• National Colorectal Cancer Awareness Month is Almost Over - Don’t Forget to Follow Up (CMS Message 201203-62)
• Important Message from the Commissioner of Social Security to Healthcare Providers - On Thu Mar 22, Commissioner Astrue signed an Open Letter to Healthcare Providers, Health Information Managers, and Medical Records Administrators about Social Security’s new electronic signature process for Form SSA-827, “Authorization to Disclose Information to the Social Security Administration.” To see this important message, visit http://go.usa.gov/EUu . To learn about Social Security’s new electronic signature process, visit http://go.usa.gov/P7V . (CMS Message 201203-61)
• New CME Module on CMS Healthcare Delivery Reform Available on Medscape - On Thu Mar 22, a new CME module was posted on Medscape. This module provides information and continuing medical education (CME) about CMS’s healthcare delivery system reform efforts and can be accessed on Medscape (with a free registration) at http://www.Medscape.org/viewarticle/760133 . (CMS Message 201203-66)
• The 2012 HCPCS Jurisdiction List (CR7679) is now available
• Quarterly Update for HCPCS Codes Effective Sun July 1 (CMS Message 201204-07)

March

30 March 2012

• Questionable Billing By Suppliers of Lower Limb Prostheses (SE1213)
• Round 2 and National Mail-Order Competitions of the DMEPOS Competitive Bidding Program (CMS Message 201203-57)
• Delay of the Implementation Date of the PWK (Paperwork) Segment
• December 2011 CERT Errors
• The following New Online Tutorial has been added:
  • Power Operated Vehicles
• Test Your Knowledge - The Nebulizer Quiz is Now Available
• New and Updated Frequently Asked Questions (FAQs) are now available
• The following Fee Schedules have been added:
  • There are no updates to the 2nd Quarter 2012 Jurisdiction A DME MAC Fee Schedule
  • 2nd Quarter 2012 Average Sales Price Medicare Part B Drug Pricing File
  • 2nd Quarter 2012 Oral Anticancer Drug Fees

26 March 2012

• The 2012 DME MAC Jurisdiction A Symposium Program Schedule page has been updated. Presentation Handouts are now available.

23 March 2012

• Extension of Enforcement Discretion Period for Updated HIPAA Transaction Standards through June 30, 2012 (CMS Message 201203-25)
• Centers for Medicare & Medicaid Services (CMS) Spreadsheets for 5010A1 Edits Updated (CEDI Message)
• March is National Colorectal Cancer Awareness Month - Is Your Practice Ready? (CMS Message 201203-32)
• March is National Colorectal Cancer Awareness Month - Encourage Your Patients to Get Screened (CMS Message 201203-48)
• Happy Second Anniversary to the Affordable Care Act (CMS Message 201203-52)
• New Fast Fact on MLN Provider Compliance Webpage - A new fast fact is now available on the MLN Provider Compliance webpage . This webpage provides the latest Medicare Learning Network products designed to help Medicare Fee-For-Service providers understand - and avoid - common billing errors and other improper activities. Please bookmark this page and check back often as a new fast fact is added each month! (CMS Message 201203-50)
• “CMS Website Wheel” Educational Tool Revised - The CMS Website Wheel educational tool (ICN 006212) has been revised; this educational tool is available only in hardcopy. It is designed to provide a variety of CMS Medicare related website addresses, including URLs for topics such as ICD-10, E-Prescribing, 5010, and more. To order hardcopies of this product, visit http://www.CMS.gov/MLNProducts and click on ‘MLN Product Ordering Page’ under ‘Related Links Inside CMS’ at the bottom of the webpage. (CMS Message 201203-50)
• “Basics of DMEPOS Accreditation” Fact Sheet Revised - “The Basics of DMEPOS Accreditation” fact sheet (ICN 905710) has been revised and is now available in downloadable format. This fact sheet is designed to provide education on durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and includes information so suppliers can meet DMEPOS Quality Standards established by the CMS and become accredited by a CMS-approved independent national Accreditation Organization. It also includes information on the types of providers who are exempt. (CMS Message 201203-50)
• “DMEPOS Information for Pharmacies” Fact Sheet Revised - The “DMEPOS Information for Pharmacies” fact sheet (ICN 905711) has been revised and is now available in downloadable format. This fact sheet is designed to provide education for pharmacies on durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and includes information on accreditation by a CMS-approved independent national accreditation organization as well as information for pharmacies want to be considered for an exemption from the accreditation requirements. (CMS Message 201203-50)
• Announcements from the ICD-9-CM Coordination and Maintenance Committee
  Summary Report from Committee Meeting on Mon Mar 5, 2012 - The Summary Report from the procedure part of the Mon Mar 5 ICD-9-CM Coordination and Maintenance Committee Meeting is now available at http://www.CMS.gov/ICD9ProviderDiagnosticCodes/ICD9/list.asp .
  
  For information related to diagnosis code issues, please visit the Classifications of Diseases, Functioning, and Disability page on the Centers for Disease Control and Prevention (CDC) website. The CDC will post the Summary Report of the diagnosis part of the meeting on this webpage.
  
  Registration for Meeting on Wed Sep 19 and Thu Sep 20, 2012 - Registration for the ICD-9-CM Coordination and Maintenance Committee to be held Wed Sep 19 and Thu Sep 20 will open on Fri Aug 17. More information will be posted soon on the ICD-9-CM Coordination and Maintenance Committee webpage. (CMS Message 201203-54)
• New Materials Now Available for the ICD-10 MS-DRG Conversion Project - CMS has posted v29 of the ICD-10 MS-DRGs and an updated version of the v27 Medicare Code Editor (MCE) on the ICD-10 MS-DRG Conversion Project webpage. These materials are available in the “Downloads” section of the webpage.
  
  The updated version of the v27 MCE is being referred to as v27.0 R1 (MCE v27 R1). This Wed Mar 14 update corrects some errors in the documentation previously posted. The v27 MCE logic is used in the CMS Medicare Severity Grouper with MCE ICD-10 R1 Pilot Software (Version 28.0) that is being sold by NTIS . (CMS Message 201203-54)

16 March 2012

• Revision of Medicare Summary Notice (MSN) for Non-Competitive Bid Claims (MM7729)
• The article Use of Revised Remittance Advice Remark Code (RARC) N103 When Denying Services Furnished to Federally Incarcerated Beneficiaries (MM7678) has been revised
• Clarification on Submission of the Correct “Amount Paid” on Assigned Claims - Item 29 of the CMS-1500 Claim Form or Electronic Equivalent
• Annual DME CSI/VPIQ Validation Will Begin Soon
• Medicare Redesigns Claims and Benefits Statement (CMS Message 201203-20)
• March is National Nutrition Month (CMS Message 201203-21)
• Raise Awareness in March about Kidney Disease - National Kidney Disease Month (CMS Message 201203-22)
• Health Reform Law Ends Lifetime Limits for 105 Million Americans (CMS Message 201203-23)
• The MLN Product Featured this month is The Medicare Overpayment Collection Process fact sheet
• DME MAC A Supplier Manual - Chapters 2, 4, 6, 7, 8, and 10 have been updated
• April 2012 Average Sales Price Files Now Available - The Centers for Medicare and Medicaid Services (CMS) has posted the April 2012 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks. All are available for download at http://www.CMS.gov/McrPartBDrugAvgSalesPrice/01a17_2012ASPFiles.asp . (CMS Message 201203-39)
• CMS.gov Website Upgrade - CMS is in the process of making upgrades to the www.CMS.gov website. If you encounter problems accessing information while on the site, please refresh the page or check back later. We appreciate your understanding and apologize for any inconvenience. (CMS Message 201203-37)

09 March 2012

• DME MAC Jurisdiction A Resource Number 23 - March 2012 is now available
• Two Version 5010 Messages: "ICD-10: It's Closer Than It Seems - Steps to Take to Refine your Version 5010 Upgrade" and "Important Update - "HIPAA Version 5010/D.0 Implementation" Document has been Updated" (CMS Message 201203-02)
• March is National Colorectal Cancer Awareness Month (CMS Message 201203-10)
• Meeting Minutes for the February 2012 Provider Outreach & Education Advisory Group Meeting are now available
• February 2012 Version of Medicare Learning Network Products Catalog Now Available - The February 2012 version of the MLN Products Catalog is now available. The MLN Products Catalog is a free interactive downloadable document that links you to online versions of MLN products or the product ordering page for hardcopy materials. Once you have opened the catalog, you may either click on the title of an individual product or on “Formats Available.” The catalog can be found at http://www.CMS.gov/MLNProducts/downloads/MLNCatalog.pdf . (CMS Message 201203-05)
• “The Role of the Zone Program Integrity Contractors, Formerly the Program Safeguard Contractors” MLN Matters Article Revised - MLN Matters Special Edition Article #SE1204, “The Role of the Zone Program Integrity Contractors (ZPICs), Formerly the Program Safeguard Contractors (PSCs) ,” has been revised is now available in downloadable format. This article is designed to provide education on the roles and responsibilities of Zone Program Integrity Contractors (ZPICs), and includes an overview of the various program integrity functions that ZPICs perform and each of their seven designated zones. The article was revised to change information cited in the table on page 2; all other information remains the same. (CMS Message 201203-05)
• Ordering/Referring Reports Now Contain Complete National Provider Identifier - In response to concerns raised by the provider community, CMS is including the complete NPI on the following ordering & referring reports found on the CMS website at http://www.CMS.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp (in the ‘Downloads’ section of the page): Ordering/Referring Report, Initial Physician Applications Pending Contractor Review, Initial Non Physician Applications Pending Contractor Review (CMS Message 201203-15)

02 March 2012

• The article The Role of the Zone Program Integrity Contractors (ZPICs), Formerly the Program Safeguard Contractors (PSCs) (SE1204) has been revised
• Redetermination Acknowledgement Letters and Status Inquiries
• President Obama Signs the Middle Class Tax Relief and Job Creation Act of 2012 (CMS Message 201202-70)
• Results of Widespread Prepayment Review for Oxygen and Oxygen Equipment (HCPCS Codes E1390, E0431, and E0439)
• Standard Documentation Language for Local Coverage Determinations
• Suction Pumps Final Local Coverage Determination Released
• LCD and Policy Article Revisions - Summary for March 1, 2012
• The following Local Coverage Determinations (LCDs) / Medical Policies have been revised:
  • Ankle-Foot/Knee-Ankle-Foot Orthosis
  • Immunosuppressive Drugs
  • Intravenous Immune Globulin
  • Lower Limb Prosthesis
  • Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
  • Ostomy Supplies
  • Suction Pumps
  • Wheelchair Options and Accessories
• The Suction Pumps Comments file has been posted.
• HIPAA 5010 Claims Translation Issues Affecting Medicare Crossover Claims - Error Codes H51108, H20203, and H45255 (CMS Message 201202-73)
• Crossover Claims Rejecting Due to Unnecessary Billing of Discharge Date (CMS Message 201202-75)
• Save Time - Submit Your Medicare Enrollment Application through Internet-Based PECOS, Now with e-Signature (CMS Message 201202-77)
• Were You Sent a Request to Revalidate Your Medicare Enrollment? Lists of providers sent notices to revalidate their Medicare enrollment may be found on the CMS website at http://www.CMS.gov/MedicareProviderSupEnroll/11_Revalidations.asp and in the links below. Information on revalidation letters sent in February will be posted in late March.
  • Revalidations Mailed September through October 2011
  • Revalidations Mailed November through December 2011
  • Revalidations Mailed January 2012
  CMS is working to make this information available in Internet-based PECOS (Provider Enrollment, Chain, and Ownership System) in mid April. (CMS Message 201202-76)

February

24 February 2012

• Healthcare Fraud Prevention and Enforcement Efforts Result In Record-Breaking Recoveries Totaling Nearly $4.1 Billion (CMS Message 201202-52)
• Resolution of the 5010 Electronic Claims Submission 496 Edit (CMS Message 201202-59)
• November 2011 CERT Errors
• A new DMEPOS Express Podcast - DME MAC A Symposiums - Registration Open has been posted.
• Test Your Knowledge - The Vision Quiz is Now Available
• The Role of the Zone Program Integrity Contractors (ZPICs), Formerly the Program Safeguard Contractors (PSCs) (SE1204)
• “Role of the Zone Program Integrity Contractors, Formerly the Program Safeguard Contractors” MLN Matters Article Released - MLN Matters Special Edition Article #SE1204, “The Role of the Zone Program Integrity Contractors (ZPICs), Formerly the Program Safeguard Contractors (PSCs) ,” has been released in downloadable format. This article is designed to provide education on the roles and responsibilities of the ZPICs, and includes an overview of the various program integrity functions that ZPICs perform and each of their seven designated zones. (CMS Message 201202-65)
• From the MLN: MLN Matters Articles Search Tips - Looking for the latest new and revised MLN Matters® articles? The Medicare Learning Network® offers several ways to search and quickly find articles of interest to you (CMS Message 201202-65):
  • MLN Matters Search Engine - An advanced search feature that allows you to search MLN Matters articles from 2004 to the current year. For more information and introductions on how to use the search engine, visit the MLN Matters Search Tips webpage at http://www.CMS.gov/MLNMattersArticles/02_Search.asp .
  • MLN Matters Index - A list of common keywords and phrases contained within MLN Matters articles. Each index is organized by year with the ability to search by specific keywords and topics. Most indices link directly to the related article(s). For a list of available indices, visit http://www.CMS.gov/MLNMattersArticles/01_Overview.asp and scroll to the ‘Downloads’ section of the page.
  • MLN Matters Dynamic Lists - An archive of previous and current articles organized by year with the ability to search by keyword, transmittal number, subject, article number, and release date. To view and search articles, select the desired year from the left column on the MLN Matters Article webpage at http://www.CMS.gov/MLNMattersArticles .
  • MLN Matters Electronic Mailing List - A free notification of new and revised MLN Matters articles as they are released. For more information, including how to subscribe to the service, visit http://www.CMS.gov/MLNMattersArticles/downloads/What_Is_MLNMatters.pdf . You can also view and search an archive of previous messages at http://list.nih.gov/cgi-bin/wa.exe?A0=MLNMATTERS-L .

20 February 2012

• Registration Now Open - 2012 DME MAC Symposiums - Knowledge is Key - The DME MAC Jurisdiction A Provider Outreach & Education Team is excited to announce that we will be hosting two Educational Symposiums offering a dynamic range of topics and speakers. In addition, attendees will have the opportunity to interact directly with various Medicare Contractors and State DMEPOS Associations in order to enhance their educational experience and get the most out of this excellent opportunity.

17 February 2012

• HHS Announces Intent to Delay ICD-10 Compliance Date (CMS Message 201202-45)
• Immediate Recoupment for Fee for Service Claims Overpayments (MM7688)
• Updating Beneficiary Information with the Coordination of Benefits Contractor (SE1205)
• Health Care Fraud Prevention And Enforcement Efforts Result In Record-Breaking Recoveries Totaling Nearly $4.1 Billion (CMS Press Release 02/14/2012)
• Medicare Proposes New Steps To Protect Taxpayer Dollars (CMS Press Release 02/14/2012)
• CMS Furnishes List of Off-the-Shelf Orthotic Healthcare Common Procedures Coding System Codes (CMS Message 201202-28)
• Three Electronic Health Record (EHR) Messages (CMS Message 201202-23)
• February is American Heart Month (CMS Message 201202-27)
• Only 2 Weeks Until the Covered Document Review Date for DMEPOS Competitive Bidding Round 2 and National Mail-Order Competition (CMS Message 201202-44)
• New DMEPOS Competitive Bidding Program Analysis Shows No Changes in Health Outcomes (CMS Message 201202-43)
• Medicare Proposes New Steps to Protect Taxpayer Dollars - Affordable Care Act Gives New Authority To Recover Overpayments More Quickly (CMS Message 201202-38)
• ASC X12 Decides Against Proposing Version 6020 for Consideration as Next Version of Standard Under HIPAA (CMS Message 201202-37)
• Major Improvements to Medicare Online Enrollment System (CMS Message 201202-47)
• HHS Releases Reports on Improved Access to Preventive Services Under the Affordable Care Act (CMS Message 201202-49)
• “Oxygen Therapy Supplies: Complying with Documentation & Coverage Requirements” Fact Sheet Revised - The “Oxygen Therapy Supplies: Complying with Documentation & Coverage Requirements” fact sheet (ICN 904883) has been revised and is now available in downloadable format. This fact sheet is designed to provide education on common Comprehensive Error Rate Testing (CERT) Program errors related to oxygen therapy, and includes a checklist of the documentation needed to support a claim submitted to Medicare for oxygen therapy supplies. (CMS Message 201202-24)
• "Updating Beneficiary Information with Coordination of Benefits Contractor” MLN Matters Article Released - MLN Matters Special Edition Article #SE1205, “Updating Beneficiary Information with the Coordination of Benefits Contractor ,” has been released and is available in downloadable format. This article is designed to provide education on initiatives that CMS and the Coordination of Benefits Contractor (COBC) are undertaking to maintain accurate beneficiary Medicare Secondary Payer (MSP) information on Medicare’s Common Working File (CWF). It includes information that providers can use to understand how these initiatives will affect how they report beneficiary information to the COBC. (CMS Message 201202-42)
• New Fast Fact on MLN Provider Compliance Webpage - A new fast fact is now available on the MLN Provider Compliance webpage. This webpage provides the latest Medicare Learning Network products designed to help Medicare Fee-For-Service providers understand - and avoid - common billing errors and other improper activities. Please bookmark this page and check back often as a new fast fact is added each month! (CMS Message 201202-42)
• Important Update Regarding HIPAA Version 5010/D.0 Implementation - CMS has posted to the Versions 5010 & D.0 webpage a new document titled Important Update Regarding HIPAA Version 5010/D.0 Implementation, which includes descriptions used for interpreting the 277CA responses, and can be found at http://www.CMS.gov/versions5010andd0/01_overview.asp . This document also includes links to the Common Edits and Enhancement Module (CEM) Error Description documents. (CMS Message 201202-46)

10 February 2012

• Extension of Licensure Deadline for the Round 2 and National Mail-Order Competitions of the DMEPOS Competitive Bidding Program (CMS Message 201202-07)
• Preparing for the Version 5010 Upgrade: Questions to Ask Your Vendor (CMS Message 201202-16)
• Only One Electronic Remittance Advice Recipient per NPI / Legacy ID beginning Sunday, April 1st (CMS Message 201202-01)
• Envelope Control / Reference Number Matching for Version 5010 Claim Transitions (CMS Message 201202-03)
• Two Affordable Care Act Messages (CMS Message 201202-06)
• CMS Announces Prior Authorization of Power Mobility Devices Demonstration and Recovery Audit Prepayment Review Demonstration (CMS Message 201202-10)
• The MLN Product Featured this month is the ICD-10-CM Quick Reference Guide
• The March ACT Call Information has been posted

03 February 2012

• Claim Status Category and Claim Status Codes Update (MM7670)
• April 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (MM7734)
• Bidding is Now Open for the Round 2 and National Mail-Order Competitions of the DMEPOS Competitive Bidding Program (CMS Message 201201-52)
• Now Available: New education materials for Round 2 and National Mail-Order Bidders (CMS Message 201201-51)
• The following New Online Tutorial has been added:
  • Advance Beneficiary Notice of Noncoverage (ABN) - Upgrade Billing

January

27 January 2012

• Claims against Surety Bonds for Suppliers of Durable Medical Equipment (DME), Prosthetics, Orthotics and Supplies (DMEPOS) (MM7167)
• Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers (SE1201)
• Video Slideshow Presentations from ICD-10 National Provider Calls Available on CMS YouTube Channel (CMS Message 201201-32)
• January is National Glaucoma Awareness Month (CMS Message 201201-34)
• All Medicare Provider and Supplier Payments To Be Made By Electronic Funds Transfer (CMS Message 201201-36)
• Third Anniversary of ICD-10 Rule (CMS Message 201201-40)
• Credit Report/Score Requirements for DMEPOS Competitive Bidding (CMS Message 201201-43)
• Medicare FFS Version 5010 Requirement Changes for Non-Specific Procedure Codes (CMS Message 201201-46)
• 1099-MISC Form Information
• Rendering Provider Information (CEDI Message)
• PECOS Warning Edit Change (CEDI Message)
• “Medicare Quarterly Provider Compliance Newsletter [Volume 2, Issue 2]” Released - The new “Medicare Quarterly Provider Compliance Newsletter [Volume 2, Issue 2] ” (ICN 907703) has been released in downloadable format. This educational tool is designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program, and highlights the top issues of the particular quarter. Please visit http://www.CMS.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf to download, print, and search an archive of previously-issued newsletters. (CMS Message 201201-42)
• New Fast Fact on MLN Provider Compliance Webpage - A new fast fact is now available on the MLN Provider Compliance webpage . This page provides the latest educational products designed to help Medicare Fee-For-Service providers understand - and avoid - common billing errors and other improper activities. Please bookmark this page and check back often as a new fast fact is added each month! (CMS Message 201201-35)
• “Items and Services That Are Not Covered Under the Medicare Program” Booklet and “Medicare Claim Submission Guidelines” Fact Sheet Now Available in Hardcopy - The “Items and Services That Are Not Covered Under the Medicare Program” booklet (ICN 906765), available now in hardcopy, includes information about the four categories of items and services that are not covered under the Medicare program and applicable exceptions to exclusions and the Advance Beneficiary Notice of Noncoverage. The “Medicare Claim Submission Guidelines” fact sheet (ICN 906764), available now in hardcopy as well, includes information about applying for a National Provider Identifier and enrolling in the Medicare program, filing Medicare claims, and private contracts with Medicare beneficiaries. (CMS Message 201201-35)
• “Medicare Claim Review Programs” Booklet Revised - The revised “Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and RAC” booklet (ICN 006973) is designed to provide education on the different CMS claim review programs and assist providers in reducing payment errors, including, in particular, coverage and coding errors. It includes frequently asked questions, resources, and an overview of the various programs, including Medical Review, Recovery Audit Contractor, and the Comprehensive Error Rate Testing Program. (CMS Message 201201-35)
• MLN Guided Pathways (Basic, A, and B) Provider-specific Resource Booklets Revised - The revised MLN Guided Pathways curriculum is designed to allow learners to easily identify and select resources by clicking on topics of interest. The curriculum begins with basic knowledge for all providers and then branches to information for either those enrolling on the 855B, I, and S forms or on the 855A form (or Internet-based PECOS equivalents). The resource booklets are (CMS Message 201201-35):
  • MLN Guided Pathways to Medicare Resources - Basic Curriculum for Health Care Professionals, Suppliers, and Providers
  • MLN Guided Pathways to Medicare Resources Intermediate Curriculum for Health Care Providers (Part A)
  • MLN Guided Pathways to Medicare Resources Intermediate Curriculum for Health Care Professionals and Suppliers (Part B)
• “MLN Guided Pathways Provider-specific” Resource Booklet Revised - The Revised MLN Guided Pathways to Medicare Resources provider-specific resource booklet provides various specialties of healthcare professionals, (physicians, chiropractors, optometrists, podiatrists), nurses (APN, RNCNS, NP, Midwife) PAs, social workers, psychologists, therapists (OT, PT, SLP), dietitians, nutritionists, suppliers (ambulance, ASC, DMEPOS, FQHC, RHC, Labs, mammography, radiation therapy, portable x-ray), and providers (CMHC, CORF, ESRD, HHA, hospice, OPT, pathology and SNF) with resources specific to their specialty including Internet-Only Manuals (IOMs), Medicare Learning Network® publications, CMS webpages, and more. This version includes the addition of pathways for Anesthesiology Assistant/Certified Registered Nurse Anesthetist, Anesthesiologist, Ophthalmologist, and Optometrist, along with a fully developed pathway for Mass Immunization Roster Biller. All of the MLN Guided Pathways booklets above are available at http://www.CMS.gov/MLNEdWebGuide/30_Guided_Pathways.asp (CMS Message 201201-35)
• A new DMEPOS Express Podcast - Glucose Documentation has been posted.
• New and Updated Frequently Asked Questions (FAQs) are now available
• Test Your Knowledge - The Oxygen Quiz is Now Available

19 January 2012

• The following New Online Tutorials have been added:
  • New Supplier/Employee Training: Introduction to DME MAC Billing
  • Patient Lifts
• The article Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process (SE1137) has been revised
• The article Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims (SE1138) has been revised
• Now Available: New Webcast for Round 2 and National Mail-Order Bidders (CMS Message 201201-25)
• Clarification Concerning HIPAA 5010 and NCPDP D.0 Cut-Over and Impacts on Crossover Claims (CMS Message 201201-28)
• The Q&A document for the December 20, 2011 ACT Call has been posted

13 January 2012

• Use of Revised Remittance Advice Remark Code (RARC) N103 When Denying Services Furnished to Federally Incarcerated Beneficiaries (MM7678)
• The article Recovery Audit Program: Medicare Administrative Contractor (MAC)-issued Demand Letters (MM7436) has been revised
• October 2011 CERT Errors
• CEDI Reminder: 5010A1/D.0 Implementation Plans (CEDI Message)
• HHS Adopts HIPAA Standard for Electronic Funds Transfers/Remittance Advice (CMS Message 201201-10)
• Three DMEPOS Competitive Bidding Announcements (CMS Message 201201-12)
• Time is Running Out to Register for DMEPOS Competitive Bidding (CMS Message 201201-13)
• Now Available: New Webcast for National Mail-Order Bidders (CMS Message 201201-14)
• Stay on Track and Complete Your Version 5010 Upgrade (CMS Message 201201-15)
• Extension of Moratorium That Allows Independent Laboratories to Bill for the Technical Component (TC) of Physician Pathology Services Furnished to Hospital Patients (CMS Message 201201-17)
• The MLN Product Featured this month is The Basics of Internet-based PECOS for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers booklet
• Healthcare Common Procedure Coding System (HCPCS) Code Set Update - 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.gov/medhcpcsgeninfo. Changes are effective on the date indicated on the update. (CMS Message 201201-18)

11 January 2012

• The following Fee Schedules have been added:
  • 1st Quarter 2012 Jurisdiction A DME MAC Fee Schedule
  • 1st Quarter 2012 Average Sales Price Medicare Part B Drug Pricing File
  • 1st Quarter 2012 Oral Anticancer Drug Fees

10 January 2012

• The finalized schedules for our February and March 2012 Educational Webinar Sessions are now available

06 January 2012

• President Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 (CMS Message 201201-01)
• Healthcare Professionals Selected for the New Innovation Advisors Program to Improve Care for Patients (CMS Message 201201-04)
• Now Available - Video Slideshow Presentation and Podcasts of the November 17 National Provider Call on “ICD-10 Implementation Strategies and Planning” (CMS Message 201201-07)
• New ASC X12 Version 5010 FAQs Posted to the CMS Website (Revised Link) - Medicare Fee-For-Service (FFS) issued an announcement Wednesday, December 14, 2011 regarding its plan for the 90 Day Discretionary Enforcement Period for non-compliant HIPAA covered entities. CMS has published six FAQ items related to this plan. These new FAQs can be found at: http://www.cms.gov/Versions5010andD0/Downloads/QandA_for_90_day_announcement.pdf . For more information on ASC X12 Version 5010, NCPDP D.0, and NCPDP 3.0; please visit http://www.CMS.gov/Versions5010andD0 . (CMS Message 201201-02)

04 January 2012

• CMS Announces Delay to the Prepayment Review and Prior Authorization for Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration (CMS Message 201112-59)

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05/11/2012