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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.
September
02 September 2010
01 September 2010
August
27 August 2010
- Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
  (MM7089)
- New Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Specialty Code for Ocularists (MM6891)
- Payment for Replacement of Oxygen Equipment in Bankruptcy Situations (MM6838)
- Discarded Drugs and Biologicals Policy at Contractor Discretion (MM7095)
- The article Medicare Policy Regarding Pressure Reducing Support Surfaces (SE1014) has been revised
- Closing in on 120 Days and Counting Until January 2011 Target Testing for Version 5010 (CMS Message 201008-37)
- Results of Widespread Prepayment Review of Claims for HCPCS Codes A4623 (Tracheostomy, Inner Cannula) and A4629 (Tracheostomy Care Kit for Established Patients)
- Submitting Refunds to NHIC, Corp. DME MAC for Jurisdiction A
- July 2010 CERT Errors
- Notes for Overpayments/MSP claims - The Offset Request and the Overpayment Referral forms have been revised. In addition, we have added a new form called Supplemental MSP Information. This new form should be used (in addition to either the Overpayment Referral or Offset Request forms) when submitting supplemental MSP information.
Please follow the instructions located at the top of each form and be sure to complete all sections pertaining to your request.
- Effective 08/30/2010, NHIC, Corp. is transitioning to US Bank. The new DME Cash Accounting (Refund Checks) address is:
NHIC, Corp.
P.O. Box 809252
Chicago, IL 60680-9252
26 August 2010
20 August 2010
19 August 2010
18 August 2010
16 August 2010
13 August 2010
- Common Working File (CWF) Unsolicited Response Adjustments for Certain Claims Denied Due to an Open Medicare Secondary Payer (MSP) Group Health Plan (GHP) Record Where the GHP Record was Subsequently Deleted or Terminated (MM6625)
- Medical Record Retention and Media Formats for Medical Records (SE1022)
- Attention DMEPOS Providers - Help DME MAC A Promote PECOS Enrollment
- August is National Immunization Awareness Month (CMS Message 201008-12)
- Important information and reminders about the upcoming Version 5010 and ICD-10 transitions (CMS Message 201008-17)
- Medicare FFS 5010 Program: Taking EDI to the Next Level- Ninth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0 Transactions (CMS Message 201008-18)
- MLN Matters Article #MM7014 - Home Health Agencies (HHAs) Providing Durable Medical Equipment (DME) in Competitive Bidding Areas - The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM7014 to alert Home Health Agencies (HHAs) that edits will be in place, effective for services on or after January 1, 2011, to prevent them from billing competitively-bid DME items in competitive bidding areas and consequently, preventing the inappropriate payment of competitively-bid DME items to HHAs. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM7014.pdf on the CMS website. (CMS Message 201008-15)
- MLN Matters Article #MM7080 - Timely Claims Filing: Additional Instructions - The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM7080 to expand the Medicare Fee-For-Service (FFS) reimbursement instructions outlined in Change Request 6960 that specified the basic timely filing standards established for FFS reimbursement. Those basic standards are a result of Section 6404 of the Patient Protection and Affordable Care Act of 2010 (ACA), which states that claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf on the CMS website. (CMS Message 201008-15)
- MLN Matters Article #MM6934 - Durable Medical Equipment National Competitive Bidding Implementation - 10G: Paying for Oxygen Equipment when Grandfathered - The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6934 to alert suppliers that a non-contract supplier who chose to be a grandfathered supplier for oxygen and oxygen equipment should also furnish additional oxygen equipment when medically necessary after the start of a Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program to beneficiaries residing in a Competitive Bidding Area (CBA) who are already receiving oxygen equipment from the grandfathered supplier, as described in Change Request 6934. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM6934.pdf on the CMS website. (CMS Message 201008-15)
- JUST RELEASED! The Medicare Learning Network is now podcasting! Our premier production - “New Maximum Period for the Submission of Medicare Claims”, which reminds Medicare Fee-for-Service providers of the current claims submission deadline, is now available. To access the podcast, go to http://www.cms.gov/CMSFeeds/02_listofpodcasts.asp on the CMS website. (CMS Message 201008-14)
- The revised National Provider Identifier Tip Sheet: Guidance for Organization Health Care Providers Who Apply for National Provider Identifiers (NPIs) for Their Health Care Provider Employees (June 2010) is now available on the CMS website. This resource details the steps an organization that is a health care provider should take when applying for an employee’s NPI, on an individual record-by-record basis. Available in PDF format, the fact sheet may be downloaded or printed from the "Education Resources" section of the NPI web pages, located at http://www.cms.gov/NationalProvIdentStand/04_education.asp on the CMS website. (CMS Message 201008-14)
- Revised! The Medicare Remit Easy Print Brochure (revised May 2010), which provides information about free software that enables professional providers and suppliers to view and print remittance information, is now available in print format from the Medicare Learning Network. To place your order, visit http://www.cms.gov/MLNGenInfo/, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.” (CMS Message 201008-14)
- September ACT Call Information Now available - DME MAC Updates and Open Q&A
12 August 2010
09 August 2010
- 2010 DME MAC Jurisdiction A Symposiums - Reading the Medicare Roadmap and Navigating Your Way to Success - The DME MAC Jurisdiction A Provider Outreach & Education Team is excited to announce that we will be hosting three 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.
06 August 2010
- The finalized schedule for our Summer Educational Webinar Sessions is now available.
- A new DMEPOS Express Podcast has been posted.
- Durable Medical Equipment National Competitive Bidding Implementation - 10G: Paying for Oxygen Equipment when Grandfathered (MM6934)
- Timely Claims Filing: Additional Instructions (MM7080)
- The article Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) (MM7006) has been revised
- Oral Anticancer Drugs - Covered Diagnoses
- 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)
- Meeting on ACA Requirements for ICD-10 Crosswalk Revisions (CMS Message 201007-57)
- SAVE THE DATES: CMS Education Series for Providers on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (CMS Message 201007-62)
- SAVE THE DATE - ICD-10 Implementation in a 5010 Environment Follow-Up National Provider Call (CMS Message 201008-02)
- Update to Banking Transition Date - The CMS awarded new banking contracts to U.S. Bank and JP Morgan Chase. Medicare providers do not have to take any action. However, providers should be aware that the Medicare payments may be made by a different bank than in the past because of these new banking contractors.
Due to issues identified in testing, providers that submit claims to CIGNA Government Services, Highmark Medicare Services, National Government Services, NHIC, and Noridian Administrative Services will experience a delay in the transition to U.S. Bank. The transition will now occur on August 30, 2010. (CMS Message 201007-61)
02 August 2010
July
30 July 2010
- On August 20th from 10:30am until 12:30pm EST the DME MAC A Call Center Customer Service Representatives will not be available due to training.
- October Quarterly Update for 2010 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule (MM7070)
- The NHIC, Corp. FAQ Database has been improved and now includes the option to sort questions by either “Date Posted” or by “Most Viewed”.
- The following Online Tutorial has been revised:
- Understanding Medical Policies and Coverage Decisions (15 Minutes)
- The following Online Tutorial has been added:
- Repairs and Replacements: Orthotics and Prosthetics (19 Minutes)
- Need to know the Medicare basics? The Medicare Learning Network (MLN) offers a series of web based training (WBT) courses to teach health care professionals the fundamentals of the Medicare Program. The first in the series, the “World of Medicare”, offers a basic introduction to Medicare. The second in the series “Your Office in the World of Medicare” focuses on Medicare knowledge required by health care professionals and their office personnel. Both activities now offer continuing education (noted by a star) and are available from the MLN at http://www.cms.gov/MLNproducts/ by scrolling to the bottom of the page and selecting Web based Training Modules from the Related Links Inside CMS section of the CMS website. (CMS Message 201007-48)
- Get your NEW How to Use the National Correct Coding Initiative (NCCI) Tools booklet from the MLN and learn how to navigate the CMS NCCI website. This new MLN product explains how to look up Medicare code pair edits and Medically Unlikely Edits (MUEs). NCCI tools can help providers avoid coding and billing errors and subsequent payment denials. If you want to become familiar with the "National Correct Coding Initiative Policy Manual for Medicare Services" and the tools on the NCCI website, this is your best resource! Go to http://www.cms.gov/MLNProducts/MPUB/list.asp and enter ‘How to’ to find this and other MLN ‘How to’ series publications. (CMS Message 201007-48)
- The Spanish Language version of “We Heard the Bells: The Influenza of 1918”, a documentary that explores the experiences of Americans during the influenza pandemic of 1918, is now available to order, free of charge, on DVD. The documentary features stories from survivors of the influenza pandemic that swept the United States in 1918. These stories serve to frame the key questions that apply to the current H1N1 pandemic. Award-winning actress S. Epatha Merkerson (Law & Order) narrates the documentary that includes information about seasonal vs. pandemic influenza, symptoms, immunizations, treatment, and research.
To order a copy of the DVD in either English or Spanish, please visit our product ordering website by first visiting our Medicare Learning Network page at: http://www.cms.gov/MLNGenInfo/01_Overview.asp, then click on “MLN Product Ordering Page” in the “Related Links Inside CMS” section. (CMS Message 201007-48)
- Attention Health Care Providers: Misdirected Mailings from Medicare - As a health care provider subject to the privacy and security requirements under the Health Insurance Portability and Accountability Act of 996 (HIPAA) and/or under State law, you must safeguard patients’ personally identifiable health information. If you receive a remittance advice on a Medicare beneficiary who’s not your patient, you should 1) destroy it and 2) report it to your fiscal intermediary, carrier, or Medicare Administrative Contractor, as appropriate. (CMS Message 201007-48)
- Revised Frequently Asked Questions (FAQs) are now available.
23 July 2010
16 July 2010
- Secretary Sebelius Announces Final Rules to Support Meaningful Use of Electronic Health Records (CMS Press Release 071310)
- Electronic Health Records at a Glance (CMS Fact Sheet 071310)
- CMS and ONC Final Regulations Define Meaningful Use and Set Standards for Electronic Health Record Incentive Program (CMS Fact Sheet 071310)
- CMS Announces Release Of New DMEPOS Competitive Bidding Program Fact Sheet For Referral Agents (CMS Message 201007-29)
- Eighth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0 Transactions (CMS Message 201007-17)
- ICD-9-CM C&M Committee to Meet September 15 on PPACA Requirements for ICD-10 Crosswalk Revisions (CMS Message 201007-20)
- HHS Issues Notice of Proposed Rulemaking to Implement HITECH Act Modifications to the HIPAA Rules (CMS Message 201007-21)
- Electronic Health Record (EHR) Incentive Program “Meaningful Use” Final Rule (CMS-0033-F) (CMS Message 201007-22)
- The MLN Product Featured this month is the Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and RAC booklet
- JUST RELEASED: MLN Matters Article #SE1024 - Recovery Audit Contractor (RAC) Demonstration High-Risk Vulnerabilities – No Documentation or Insufficient Documentation Submitted - The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1024 as the first in a series of articles concerning RAC high-dollar improper payment vulnerabilities. These articles are intended to provide education about RAC demonstration-identified vulnerabilities in an effort to prevent these same problems from occurring in the future. This article in particular focuses on Medicare’s documentation requirements and how to avoid unnecessary denial of claims. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1024.pdf on the CMS website. (CMS Message 201007-19)
- The written transcript of the Centers for Medicare & Medicaid Services’ (CMS) June 15, 2010 national provider conference call, “ICD-10 Implementation in a 5010 Environment”, is now available. To access the transcript, go to http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp on the CMS website. In the Downloads section select the “June 15, 2010 ICD-10 Conference Call” Zip file. This Zip file contains the written and audio transcripts, as well as the slide presentation used during the teleconference. Note: The length of the audio transcript is 1 hour and 51 minutes. (CMS Message 201007-24)
- New Interactive Remittance Advice (RA) added to DME MAC A Web site
- The Q&A document for the June 08, 2010 ACT Call has been revised.
13 July 2010
07 July 2010
- Medicare to Save Average of 32 Percent for Some Medical Equipment and Supplies in Selected Areas
- Billing Reminder: Same/Similar Guidelines for Group I and Group II Pressure Reducing Support Surfaces
- 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 web page at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp. Changes are effective on the date indicated on the update. (CMS Message 201007-03)
- CMS Announces DMEPOS Competitive Bidding Payment Amounts - The Centers for Medicare & Medicaid Services (CMS) has announced the single payment amounts for the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. To view the Press Release, please click: http://www.cms.hhs.gov/apps/media/press_releases.asp To view the Fact Sheet, please click: http://www.cms.hhs.gov/apps/media/fact_sheets.asp Visit the CMS web site at: http://www.cms.gov/DMEPOSCompetitiveBid/01A1_Announcements_and_Communications.asp#TopOfPage to view additional information. (CMS Message 201007-01)
- The Centers for Medicare & Medicaid Services (CMS) announces the availability of a new fact sheet that discusses changes The Patient Protection and Affordable Care Act (PPACA) made to the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. The changes extend the deadline for pharmacies to submit to the Secretary evidence of accreditation until January 1, 2011. In addition, pharmacies that furnish durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) may qualify for an exemption to such requirements if the pharmacy meets certain criteria. For more information on these changes and criteria, please see the fact sheet at the following link: http://www.cms.gov/MedicareProviderSupEnroll/Downloads/DMEPOSAccExemptForCertainPharmaciesFactSheet.pdf (CMS Message 201007-10)
- The Q&A document and handout are now available for the June 08, 2010 ACT Call.
- The following Online Tutorial has been revised:
- Comprehensive Error Rate Testing (CERT) (14 Minutes)
- The following Fee Schedules have been added:
- 3rd Quarter 2010 Jurisdiction A DME MAC Fee Schedule
- 3rd Quarter 2010 Average Sales Price Medicare Part B Drug Pricing File
- 3rd Quarter 2010 Oral Anticancer Drug Fees
02 July 2010
- October 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (MM7007)
- Guidance on Implementing Section 3109 of the Patient Protection and Affordable Care Act (ACA) (MM7021)
- May 2010 CERT Errors
- Results of Widespread Prepayment Review of Claims for Continuous Positive Airway Pressure Devices (E0601)
- One-Time Letter to Physicians and Non-Physician Practitioners Who Are Currently Enrolled In Medicare But Not Enrolled in PECOS
- Something New From The Medicare Learning Network (MLN) for Billing and Coding Professionals (CMS Message 201006-43)
- Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program (DMEPOS CBP) ACA Section 3136 Power-Driven Wheelchairs (CMS Message 201006-52)
- Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program (DMEPOS CBP) Appeals Process for Termination of Competitive Bidding Contract Provisions for Notice of Proposed Rulemaking (1503-P) (CMS Message 201006-53)
- Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program (DMEPOS CBP) Medicare Payment for Grandfathering Provisions for Notice of Proposed Rulemaking (1503-P) (CMS Message 201006-54)
- Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Provisions in 2011 Physician Fee Schedule's Notice of Proposed Rulemaking (CMS Message 201006-56)
- CMS to Review PECOS Enrollment Process - Medicare Working with Ordering and Referring Providers and Suppliers to Streamline Enrollment Process (CMS Message 201006-57)
- The Centers for Medicare and Medicaid Services (CMS) has posted a revised July 2010 ASP Pricing file, which is available for download at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/ (see left menu for year-specific links). (CMS Message 201006-41)
- The audio transcript of the June 15, 2010 national provider conference call, "ICD-10 Implementation in a 5010 Environment", hosted by the Centers for Medicare & Medicaid Services (CMS) is now available. To access the transcript, go to http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp#TopOfPage on the CMS website. In the Downloads section select the June 15, 2010 ICD-10 Conference Call Zip file. The audio transcript is 1 hour and 51 minutes in length. The written transcript will be available soon. (CMS Message 201006-55)
June
25 June 2010
- ICD-10 Implementation Information (SE1019)
- The article Durable Medical Equipment National Competitive Bidding Implementation -- Phase 10C: Exception for Medicare Beneficiaries Previously Enrolled in a Medicare Advantage Plan (MM6918) has been revised
- Statement on the One Year Anniversary of Obama "Year Of Community Living" Initiative (CMS Message 201006-39)
- Version 5010 and ICD-10 are coming. Will you be ready? (CMS Message 201006-34)
- CMS to Host 7th National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0 Transactions (CMS Message 201006-22)
- Getting Started With Internet-based Provider Enrollment, Chain and Ownership System (PECOS) - Information for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (CMS Message 201006-22)
- The Electronic Health Record (EHR) Incentive Program Website is now available on CMS.gov! The Centers for Medicare & Medicare Services (CMS) has launched the official website for the Medicare & Medicaid EHR Incentive Programs. This website provides the most up-to-date, detailed information about the EHR incentive programs. The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals and hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. Bookmark this site and visit http://www.cms.gov/EHRIncentivePrograms/ often to learn about who is eligible for the programs, how to register, meaningful use, upcoming EHR training and events, and much more! (CMS Message 201006-21 and 201006-25)
- On June 18, 2010 the Office of the National Coordinator for Health Information Technology (ONC) issued a final rule to establish a temporary certification program for EHR technology. http://www.hhs.gov/news/press/2010pres/06/20100618d.html (CMS Message 201006-26)
- July 2010 Average Sales Price (ASP) Files Are Now Available - The Centers for Medicare and Medicaid Services (CMS) has posted the July 2010 ASP and NOC pricing files and crosswalks. The ASP pricing files for April 2010, January 2010, October 2009, and July 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 201006-28)
- REMINDER: The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 - Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 – Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months to advise providers who submit claims to Medicare contractors that, as a result of the Affordable Care Act (ACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website. (CMS Message 201006-33)
- MLN Matters Article #SE1019 - ICD-10 Implementation Information - The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1019 to provide updated information about the implementation of the International Classification of Diseases, 10th Edition, Clinical Modification and Procedure Coding System (ICD-10-CM/ICD-10-PCS) code. The first ICD-10-related compliance date is less than 2 years away - on January 1, 2012, standards for electronic health transactions change from Version 4010/4010A1 to Version 5010. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1019.pdf on the CMS website. (CMS Message 201006-38)
- The audio transcript of the June 15, 2010 national provider conference call, “ICD-10 Implementation in a 5010 Environment”, hosted by the Centers for Medicare & Medicaid Services (CMS) is now available. To access the transcript, go to http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp on the CMS website. In the Downloads section select the June 15, 2010 ICD-10 Conference Call Zip file. The audio transcript is 1 hour and 51 minutes in length. The written transcript will be available soon. (CMS Message 201006-40)
- Nebulizers Widespread Review: Notification of Continuation of Complex Review
- Meeting Minutes for the May 2010 Provider Outreach & Education Advisory Group Meeting are now available.
24 June 2010
18 June 2010
15 June 2010
11 June 2010
- DME MAC Jurisdiction A Resource Number 16 - June 2010 is now available
- Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC) or from one Durable Medical Equipment (DME) MAC to another DME MAC (SE1017)
- Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC) or from one Durable Medical Equipment (DME) MAC to another DME MAC (SE0837)
- HHS, CMS and the Administration on Aging Launch Fraud Prevention Education Campaign (CMS Message 201006-11)
- JUST RELEASED: MLN Matters Article #SE1017 - Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC) or From One Durable Medical Equipment (DME) MAC to Another DME MAC - The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1017 to assist all providers that will be affected by Medicare Administrative Contractor (MAC) implementations, or DME MAC transitions due to recompeting DME MAC Contracts. This article updates material contained in MLN Matters Article #SE0837, which was originally issued in November 2008, to reflect current experiences with transitions to a MAC. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1017.pdf on the CMS website. (CMS Message 201006-04)
- The Medicare Preventive Services Resources CD, which contains PDF files of our Medicare Preventive Services educational products on a single convenient CD Rom, is now available for order through the Medicare Learning Network - free of charge! The CD includes the following products: The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals, All 3 Quick Reference Billing Charts (Medicare Preventive Services, The ABCs of the IPPE, and Medicare Immunization Billing), and All 7 brochures (Adult Immunization, Bone Mass Measurements, Cancer Screenings, Diabetes-Related Services, Expanded Benefits, Glaucoma Screening, and Smoking and Tobacco-Use Cessation Counseling Services). To order a free copy of the CD, please visit the Preventive Services Educational Products page at http://www.cms.gov/MLNProducts/35_PreventiveServices.asp on the CMS website. Scroll down to the “Related Links Inside CMS” section and click on “MLN Product Ordering”. (CMS Message 201006-04)
9 June 2010
4 June 2010
- Mounting Hardware - E1028 - Billing Reminder
- External Infusion Pump LCD Immune Globulin Subcutaneous (Human), 20% Liquid (Hizentra™)
- Power Wheelchair Electronics Clarification
- CERT Physician Letter - Enteral Nutrition
- April 2010 CERT Errors
- Implementation of the new Health Insurance Portability and Accountability Act Formats for all Durable Medical Equipment Medicare Administrative Contractor Electronic Trading Partners
- A Message from Dr. David Blumenthal: "There Is No 'One-Size-Fits-All' in Building a Nationwide Health Information Network (CMS Message 201005-35)
- ICD-10 Implementation in a 5010 Environment National Provider Conference Call (CMS Message 201005-41)
- REMINDER: The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 - Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months to advise providers who submit claims to Medicare contractors that, as a result of the Affordable Care Act (ACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website. (CMS Message 201005-39 and 201005-43)
- The Centers for Medicare & Medicaid Services (CMS) has posted on its website 11 new frequently asked questions (FAQ) about the ICD-10 Implementation. To access these FAQs, please visit the CMS ICD-10 web page at, http://www.cms.gov/ICD10/ , select the Medicare Fee-for-Service Provider Resources link on the left side of the page, scroll down the page to the “Related Links Inside CMS” section and select “ICD-10 FAQs”. Please check the ICD-10 FAQ section regularly for newly posted or updated ICD-10 FAQs. (CMS Message 201005-40)
- Do you ever wonder about how to utilize search tools in selected areas of the CMS website? 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 revised How to Use the Medicare Coverage Database booklet 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 201005-42)
- Feeling Lost in Your Search for Medicare Knowledge? Let MLN Guided Pathways Get You Back on Track. With the revised (April 2010) Guided Pathways to Medicare Resources, finding Medicare information has never been so easy! Guided Pathways leads Medicare Fee-For-Service providers through a variety of resources that are organized by important topics such as billing, coverage, and reimbursement, and are offered in basic, intermediate, and advanced levels. Explore these easy-to-navigate online guides to quickly find the information you need on important Medicare policy and requirements. Available at http://www.cms.hhs.gov/MLNEdWebGuide/30_Guided_Pathways.asp on the CMS website. (CMS Message 201005-42)
- CMS would like to remind you that the Medicare Preventive Services Series Part 3 web-based training course (WBT) is currently available for free, on the CMS website.
This course includes coverage, coding, and billing information for Medicare coverage of the following preventive services: Screening mammography, Screening pap tests and pelvic examinations, Colorectal cancer screening, Bone mass measurements, and Glaucoma screening.
Taking this online course will help you and your staff understand Medicare rules surrounding these important benefits. Not only that, but if you pass this course, you can earn continuing education credit.
You can take access this course, free of charge, at any time, by visiting the Preventive Services Educational products page at http://www.cms.gov/MLNProducts/35_PreventiveServices.asp on the CMS website. Scroll down to the “Related Links Inside CMS” section and click on “Web Based Training Modules” to take the course. (CMS Message 201005-42)
May
28 May 2010
- Quarterly Healthcare Common Procedure Coding System (HCPCS) Code Changes – July 2010 Update (MM6809)
- Updated Form CMS-1500 Information (MM6929)
- The article Discarded Drugs and Biologicals Updates (MM6711) has been revised
- The article Guidance on Implementing System Edits for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (MM6566) has been revised
- Provider Contact Center (PCC) Changes Training Closure Time - SAVE THE DATE
- Updated Banking Transition (CMS Message 201005-31)
- The Latest on the Centers for Medicare & Medicaid Services (CMS) ICD-10 Website Section (CMS Message 201005-34)
- CMS Sends Medicare Mailing to Beneficiaries to Educate Them on the New Affordable Care Act and What it Means for Medicare (CMS Message 201005-37)
- JUST RELEASED: MLN Matters Article #SE1016 - Re-Assignment of Certain Providers to Jurisdiction 1 and Jurisdiction 4 Medicare Administrative Contractors (MACs) - The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1016 to clarify CMS' approach for assigning providers to MACs and to discuss the process of moving providers to MACs, as described in Change Requests (CRs) 5979, 6569, and 6902. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1016.pdf on the CMS website. (CMS Message 201005-33)
- REMINDER: The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 - Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months to advise providers who submit claims to Medicare contractors that, as a result of the Affordable Care Act (ACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website. (CMS Message 201005-33)
- Medical Review (MR) Requests for Additional Documentation (ADR) Responses - Address now available
21 May 2010
- Clinical Review Judgment (MM6954)
- The following new Online Tutorial has been posted:
- Payment Category Modifiers (19 Minutes)
- Seeking Your Feedback - 2010 DME MAC A Educational Symposiums
The DME MAC A Provider Outreach & Education Team is seeking your feedback to help choose locations and topics for our next round of Educational Symposiums. These symposiums are scheduled to be held in the fall of this year. Survey completion should take less than 5 minutes and is available at: http://www.surveymonkey.com/s/BYSRH3J
Note: Accurate results are important; therefore, each person should only complete the survey once prior to the June 04, 2010 deadline.
We appreciate your participation and look forward to seeing you at a future event!
20 May 2010
14 May 2010
- July Quarterly Update for 2010 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule (MM6945)
- Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months (MM6960)
- Change in the Amount in Controversy (AIC) Requirement for Administrative Law Judge Hearings and Federal District Court Appeals (MM6894)
- Change in Claims Filing Jurisdiction for Tracheo-Esophageal Voice Prostheses Healthcare Common Procedure Coding System (HCPCS) Code (MM6743)
- Medicare Policy Regarding Pressure Reducing Support Surfaces (SE1014)
- Special Open Door Forum: Medicare Provider & Supplier Enrollment (CMS Message 201005-10)
- Sixth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0 Transactions (CMS Message 201005-12)
- CMS 2010 ICD-10/5010 National Provider Conference Call (CMS Message 201005-13)
- Time Is Running Out - Have You Responded? (CMS Message 201005-15)
- May 9-15 is National Women’s Health Week! (CMS Message 201005-18)
- A Health Information Technology Update (CMS Message 201005-21)
- Billing Reminder: Narrative Requirements for Supplies and Accessories Used with Beneficiary Owned Equipment
- NEW: Special Edition MLN Matters Article #SE1014 - Medicare Policy Regarding Pressure Reducing Support Surfaces - The Centers for Medicare & Medicaid Services (CMS) has released a Special Edition MLN Matters article to clarify existing support surface medical policies and coverage requirements. The article, SE1014, “Medicare Policy Regarding Pressure Reducing Support Surfaces,” reinforces existing policy and does not present any new policy. It is available at http://www.cms.gov/MLNMattersArticles/downloads/SE1014.pdf on the CMS website. (CMS Message 201005-17)
- JUST RELEASED: MLN Matters Article #MM6960 - Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months - The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 to advise providers who submit claims to Medicare contractors that, as a result of the Affordable Care Act (ACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website. (CMS Message 201005-22)
- REVISED: Special Edition MLN Matters Article #SE1008 - Medicare Coverage of Blood Glucose Monitors and Testing Supplies - The Centers for Medicare & Medicaid Services (CMS) has revised MLN Matters Article #SE1008, “Medicare Coverage of Blood Glucose Monitors and Testing Supplies,” to include additional information regarding special blood glucose monitors for patients with manual dexterity issues, and to clarify certain information regarding the content of orders and when new orders are needed. The article is available at http://www.cms.gov/MLNMattersArticles/downloads/SE1008.pdf on the CMS website. (CMS Message 201005-17)
- DME MAC A Supplier Manual - Chapters 3 and 8 have been updated
- June 8, 2010 HCPCS Public Meeting Agenda for Durable Medical Equipment - The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of the June 8, 2010 HCPCS Public Meeting Agenda for Durable Medical Equipment. This document and the link for the corresponding public meeting registration are located on the HCPCS website at http://www.cms.gov/MedHCPCSGenInfo/08_HCPCSPublicMeetings.asp (CMS Message 201005-23)
- Test Your Knowledge - The Vision Quiz is Now Available.
07 May 2010
- Enhancements to Home Health (HH) Consolidated Billing Enforcement (MM6911)
- Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update (MM6901)
- Durable Medical Equipment National Competitive Bidding Implementation - Phase 10C: Exception for Medicare Beneficiaries Previously Enrolled in a Medicare Advantage Plan (MM6918)
- Addition of Repair Codes to the List of Healthcare Common Procedure Coding System (HCPCS) Codes Payable Under the Instructions Provided in Change Requests (CRs) 6573 and 5917 (MM6914)
- Payment of Oxygen Contents to Suppliers after the 36th Month Rental Cap under the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (MM6939)
- Discarded Drugs and Biologicals Updates (MM6711)
- The article Medicare Coverage of Blood Glucose Monitors and Testing Supplies (SE1008) has been revised
Note: If the “unavailable” notice appears when you go to the link for SE1008 then refresh your browser and the newly revised article should then load.
- 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)
- The April 2010 Edition of the Medicare Learning Network (MLN) Catalog of Products is now available and may be accessed at http://www.cms.gov/MLNproducts on the CMS website. 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. 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 called MLN Product Catalog. (CMS Message 201005-03)
- The following new Online Tutorial has been posted:
- Intravenous Immune Globulin (IVIG) Billing (14 Minutes)
- New and Updated Frequently Asked Questions (FAQs) are now available
April
30 April 2010
- The article Signature Guidelines for Medical Review Purposes (MM6698) has been revised
- The written and oral transcripts of the Basic Introduction to ICD-10-CM National Provider Conference Call, which was conducted by the Centers for Medicare & Medicaid Services on March 23, 2010, are now available in the Downloads Section at: http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp (CMS Message 201004-32)
- Special Edition MLN Matters Article #SE1008 - Medicare Coverage of Blood Glucose Monitors and Testing Supplies - The Centers for Medicare & Medicaid Services (CMS) has released a Special Edition MLN Matters article to advise providers of what glucose self-testing equipment and supplies are covered for Medicare beneficiaries and what documentation is required for the beneficiary’s medical record. The article, SE1008, “Medicare Coverage of Blood Glucose Monitors and Testing Supplies,” is available at http://www.cms.gov/MLNMattersArticles/downloads/SE1008.pdf on the CMS web site. (CMS Message 201004-35)
- The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of the 2010 HCPCS Public Meeting Agendas. May 25th and 26th is for Supplies and “Other” and May 27th is for Orthotics and Prosthetics. The documents and links for the corresponding public meeting registrations are located on the HCPCS website at http://www.cms.gov/MedHCPCSGenInfo/08_HCPCSPublicMeetings.asp (CMS Message 201004-42)
- The revised 2010 HCPCS Modifier list is now available
- Interactive Advance Beneficiary Notice (ABN) Form - The DME MAC A Outreach & Education Team has created an Interactive ABN Form. To use this form simply click on a section within the ABN Form and you will be taken to information on how to properly complete that particular section.
- New and Updated Frequently Asked Questions (FAQs) are now available
29 April 2010
23 April 2010
- Medicare Coverage of Blood Glucose Monitors and Testing Supplies (SE1008)
- March 2010 CERT Errors
- CERT Physician Letter - Positive Airway Pressure (PAP) Devices
- June ACT Call Information Now available - DME MAC Updates and Open Q&A
- The Medicare Fraud and Abuse Web-based Training Course has been revised and is now available - The course provides information helpful for Medicare providers and suppliers involved in providing and billing for services to people with Medicare. This activity provides information that will increase awareness of Medicare fraud and abuse; provide information regarding correct billing practices, and help Medicare providers, suppliers and staff to file claims correctly. The course offers continuing education credits; please see the course description page for details. To access the course, go to the MLN Products page at http://www.cms.gov/MLNProducts/ , and select the web-based training modules link in the "Related Links Inside CMS" section. Once the web-based training courses page is displayed, select the Medicare Fraud and Abuse WBT from the list provided. (CMS Message 201004-25)
16 April 2010
15 April 2010
09 April 2010
- April 5-11 is National Public Health Week and April 7 is World Health Day! (CMS Message 201004-08)
- The following Fee Schedules have been added:
- There are no updates to the 2nd Quarter 2010 Jurisdiction A DME MAC Fee Schedule
- 2nd Quarter 2010 Average Sales Price Medicare Part B Drug Pricing File
- 2nd Quarter 2010 Oral Anticancer Drug Fees
- New and Updated Frequently Asked Questions (FAQs) are now available.
- HCPCS Public Meeting Agendas for Drugs, Biologicals and Radiopharmaceuticals - The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of the May 4 & 5, 2010 HCPCS Public Meeting Agendas for Drugs, Biologicals and Radiopharmaceuticals. These documents and the link for the corresponding public meeting registrations are located on the HCPCS web site at http://www.cms.gov/MedHCPCSGenInfo/08_HCPCSPublicMeetings.asp. (CMS Message 201004-12)
- Now Available! Special Edition MLN Matters Article # SE1011 - Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696) - The Centers for Medicare & Medicaid Services (CMS) has released a Special Edition MLN Matters article that provides guidance on the edits required to be identified in Part B claims from Medicare providers or suppliers who furnish items or services as a result of orders or referrals. Medicare providers and suppliers who order or refer items or services for Medicare beneficiaries must submit an enrollment application to Medicare by using Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or by completing the paper enrollment application (CMS-855I). The article, SE1011, “Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696),” is available at http://www.cms.gov/MLNMattersArticles/downloads/SE1011.pdf on the CMS web site. (CMS Message 201004-09)
08 April 2010
07 April 2010
-
DME MAC Jurisdiction A Podcasts
All aboard the "DMEPOS Express"... next stop... knowledge!
DME MAC A is pleased to announce the addition of Podcasts to our Web site. “The DMEPOS Express” will offer brief, audio recordings concerning current topics important to you and will be presented by various Jurisdiction A subject matter experts.
02 April 2010
- Claim Status Category Code and Claim Status Code Update (MM6859)
- Reporting Changes in Surety Bonds (MM6854)
- Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696) (SE1011)
- 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 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
- Announcements Related to The Patient Protection and Affordable Care Act (PPACA) for Health Care Provider (CMS Message 201003-56)
- States (NC, CO, MS, NV, WY, and UT) to Receive Federal Matching Funds for Electronic Health Record Incentives Program (CMS Message 201003-49)
- Safety Announcement From Food and Drug Administration (FDA): High-Dose Zocor and Increased Risk of Muscle Injury (CMS Message 201003-48)
- Timely Filing Requirements for Medicare Fee-For-Service Claims (CMS Message 201004-02)
- The Patient Protection and Affordable Care Act (PPACA) - On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). The Centers for Medicare & Medicaid Services (CMS) is working hard to expeditiously implement the new law. The law's Medicare fee-for-service provisions have varying effective dates and our first priority is to address provisions with the earliest effective dates. CMS is committed to assuring Medicare providers are well informed as early as possible. For that reason, CMS is urging you to be on the alert for notices and instructions from CMS and from your Medicare fiscal intermediary, carrier, or Medicare Administrative Contractor, on forthcoming policy and operational changes as we implement the PPACA. (CMS Message 201003-54)
- The Medicare Learning Network Video is Now on You Tube!
Watch the Medicare Learning Network video - now playing on CMS’ You Tube channel at http://www.youtube.com/watch?v=GOzh7kpAwUo on the web. This information video provides you with information on what the Medicare Learning Network has to offer you in your Medicare business practices as well as other helpful resources that CMS offers to Medicare fee-for-service providers.
Don’t forget, you can also order your copy of this video on DVD today; visit http://www.cms.hhs.gov/MLNGenInfo, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.” It’s a great conference presentation! (CMS Message 201003-50)
- The Medicare Preventive Services Quick Reference Information Charts which include (1) Quick Reference Information: Medicare Preventive Services, (2) Quick Reference Information: Medicare Immunization Billing, and (3) Quick Reference Information: The ABCs of Providing the Initial Preventive Physical Examination, have been updated and are now available in hardcopy format. To order copies of these products, please visit the “Preventive Services Educational Products” page at: Watch the Medicare Learning Network video - now playing on CMS’ You Tube channel at http://www.cms.gov/MLNProducts/35_PreventiveServices.asp and select “MLN Product Ordering” in the “Related Links Inside CMS” section. (CMS Message 201003-50)
- Upcoming CMS ICD-10 Vendor Conference - On April 27, 2010, the Centers for Medicare & Medicaid Services (CMS) is hosting a CMS ICD-10 Vendor Conference. The conference is targeted to software vendors, clearinghouses, and billing services. Registration is open through April 13, 2010 and you must be registered to attend. To register or to get more information, go to http://www.cmsvendorconference.com (CMS Message 201003-51)
- Now Available! Special Edition MLN Matters Article #SE1009 - Medicare Quality Standards and Beneficiary Protections for Respiratory Equipment, Power Mobility Devices, and Other Related Durable Medical Equipment - The Centers for Medicare & Medicaid Services (CMS) has released a Special Edition MLN Matters article that provides guidance to suppliers on the Medicare quality standards for beneficiary protection and safeguard requirements related to respiratory therapy equipment, PMDs, and other related durable medical equipment. The article, SE1009, “Medicare Quality Standards and Beneficiary Protections for Respiratory Equipment, Power Mobility Devices, and Other Related Durable Medical Equipment,” is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1009.pdf on the CMS Web site. (CMS Message 201003-52)
- Centers for Medicare & Medicaid Services (CMS) Public Website Address Change - On Friday, April 2, 2010, the Centers for Medicare & Medicaid Services (CMS) will be changing our website address from http://www.cms.hhs.gov to http://www.cms.gov. Existing bookmarks and links from other websites will continue to work following this address change. (CMS Message 201004-05)
- Banking Transition - The CMS recently awarded new banking contracts to U.S. Bank and JP Morgan Chase. Medicare providers do not have to take any action. However, providers should be aware that the Medicare payments may be made by a different bank than in the past because of these new banking contractors.
The following Medicare claims processing contractors will remain with JP Morgan Chase: Cahaba Government Benefit Administrators, Pinnacle Business Solutions, First Coast Service Options, Palmetto GBA (except for A/B MAC Jurisdiction 1) and Wisconsin Physician Service. Providers that bill to these contractors will not experience any change.
The following Medicare claims processing contractors will transition to JP Morgan Chase on June 1, 2010: Palmetto A/B MAC Jurisdiction 1 and Trailblazer.
The following contractors will transition to U.S. Bank on June 1, 2010, CIGNA Government Services, Highmark Medicare Services, National Government Services, NHIC and Noridian Administrative Services. (CMS Message 201004-06)
01 April 2010
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09/02/2010 |
