Note: We can not guarantee the reliability of links to
outside sites due to the changes that Centers for Medicare & Medicaid
Services (CMS) and other organizations make. You may have to use their
Search functions when you access their sites.
2009 -
December |
November |
October |
September |
August |
July |
June |
May |
April |
March |
February |
January
2008 -
December |
November |
October |
September |
August |
July |
June |
May |
April |
March |
February |
January
2007 -
December |
November |
October |
September |
August |
July |
June |
May |
April |
March |
February |
January
2006 -
December |
November |
October |
September |
August |
July |
June
December
31 December 2009
24 December 2009
18 December 2009
15 December 2009
11 December 2009
-
CMS To Conduct Fifth Annual Medicare Contractor Provider Satisfaction Survey
 (CMS Message 200912-10)
-
REMINDER: Accreditation Time Frame for Pharmacies is January 1, 2010
(CMS Message 2009-12-03-002)
-
Providers Must Wait for Medicare Claim Crossover Process to Work
(CMS Message 2009-12-07-003)
-
Beacon Communities: Shining a Light on the Real Impacts of Health IT
(CMS Message 2009-12-07-002)
- The newly redesigned MLN Products Catalog is now available and can be viewed at
http://www.cms.hhs.gov/MLNGENINFO.
The MLN Products Catalog is an interactive downloadable document that lists all Medicare Learning Network products by media format. The catalog has been revised to provide new customer-friendly links that are embedded within the document, as well as, both subject and provider type indexes. All product titles and the word "download" when selected, will link you to the online version of the product. The word "hard copy" when selected, will automatically link you to the MLN Product Ordering page. To access the catalog, click on the link MLN Product Catalog. (CMS Message 2009-12-07-001)
- Do you ever wonder about how to utilize search tools in selected areas of the CMS web site? The searchable Medicare Coverage Database (MCD) contains all Medicare National Coverage Determinations (NCDs), National Coverage Analyses (NCAs), Local Coverage Determinations (LCDs), and local policy articles. The Medicare Learning Network (MLN) has produced a “How To” booklet (2.5 MB), that provides an explanation of the MCD, as well as how to use the Search, Indexes, Reports and Downloads features. The How to Use the Medicare Coverage Database booklet (November 2009) can be located at
http://www.cms.hhs.gov/MLNProducts/MPUB/list.asp.
on the MLN Publications page. Use search key words “how to” to locate this publication quickly. Understanding the search tool is the best way to find the information for which you are looking! (CMS Message 2009-12-03-001)
- New and Updated
Frequently Asked Questions (FAQs) are now available
04 December 2009
03 December 2009
01 December 2009
November
25 November 2009
20 November 2009
16 November 2009
13 November 2009
06 November 2009
05 November 2009
October
30 October 2009
29 October 2009
23 October 2009
16 October 2009
14 October 2009
09 October 2009
05 October 2009
02 October 2009
September
25 September 2009
18 September 2009
15 September 2009
11 September 2009
04 September 2009
03 September 2009
August
28 August 2009
- An Oxygen & Supplies CERT Physician Letter is now available
- Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplier (DMEPOS) Suppliers Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs) (MM6421)
- DME MAC Jurisdiction A Correspondence - P.O. Box Reminder
- A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology (CMS Message 200908-26)
- Vice President Biden Announces Availability of Nearly $1.2 Billion in Grants to Help Hospitals and Doctors Use Electronic Health Records (CMS Message 200908-28)
- 5010: Taking EDI to the Next Level - Third National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010 (CMS Message 200908-31)
- Medicare Demonstrations Show Paying for Quality Health Care Pays Off (CMS Message 200908-27)
- Healthcare Provider Taxonomy Codes (HPTC) October 2009 Update (CR6598)
- Medicare Fee-for-Service Emergency Preparedness Questions and Answers - The Centers for Medicare & Medicaid Services (CMS) has updated the Medicare Fee-for-Service Emergency Preparedness Questions and Answers (Qs & As). The Emergency Qs & As are posted in a document at http://www.cms.hhs.gov/Emergency/10_PandemicFlu.asp. These Qs & As include a section applicable to the H1N1 flu virus. The document is dated to reflect the posting date. As additions and changes are made to the document, the download name will change to reflect the date. Please take note that these Qs & As do not address a Section 1135 waiver situation. (CMS Message 200908-35)
- Did you miss the Information Exchange with the Department of Health & Human Services (HHS) on H1N1 Healthcare System Preparedness and Response on August 20? Did you miss the Information Exchange with HHS on H1N1 Healthcare System Preparedness and Response on August 20? You can still listen to the exchange using the Encore feature - Dial 800-642-1687, conference identification is H1N1. Also - you can continue to send questions and comment to H1N1.listening@hhs.gov. While questions cannot be answered individually, these questions will help shape the content and subject matter of the next call, scheduled for September 14. (CMS Message 200908-37)
- Registration System and Help Desk Closed Labor Day Weekend - The CMS registration system for the DMEPOS Competitive Bidding Program will be unavailable due to routine maintenance from Friday, September 4, at 9 p.m. Eastern Time until Tuesday, September 8, at 9 a.m. Eastern Time. The Competitive Bidding Implementation Contractor (CBIC) toll-free help desk will close for the Labor Day holiday on Friday, September 4, at 9 p.m. Eastern Time and will reopen on Tuesday, September 8, at 9 a.m. Eastern Time. The CBIC website, http://www.DMECompetitiveBid.com, and the Interactive Voice Response (IVR) unit will be available for registration and bidding information. (CMS Message 200908-39)
- The revised publication titled ICD-10-CM/PCS: An Introduction Fact Sheet (August 2009), which was previously titled ICD-10-Clinical Modification/Procedure Coding System Fact Sheet, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10factsheet2009.pdf. This fact sheet provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9-CM and ICD-10-CM/PCS, and implementation planning recommendations. (CMS Message 200908-33)
- ICD-10-CM/PCS Bookmark - The revised ICD-10-CM/PCS Bookmark (August 2009), which provides information about the ICD-10-Clinical Modification / Procedure Coding System (ICD-10-CM/PCS) including the benefits of adopting the coding system, recommended steps to be taken in order to plan and prepare for implementation of the coding system, and where additional information about the coding system can be found, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.” (CMS Message 200908-40)
21 August 2009
- Additional Instructions on Processing Claims for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items Submitted Under the Guidelines Established in Change Request (CR) 5917 (MM6573)
- October 2009 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (MM6585)
- Updated Healthcare Provider Taxonomy Code (HPTC) List Codes Effective October 1, 2009 (CR6598)
- Registration is Now Open for Suppliers Interested in Competitive Bidding for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (CMS Message 200908-19)
- Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Bidders’ Conference - Learn the Rules to Submit a Bid Successfully (CMS Message 2009-08-21)
- 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)
14 August 2009
- Change in Address Process for Paper Claim Submission
- Department of Health & Human Services (HHS) Delegates Authority for the Health Insurance Portability & Accountability Act of 1996 (HIPAA) Security Rule to Office for Civil Rights (CMS Message 200908-14)
- Medicare Provider Enrollment Reminder for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (CMS Message 200908-12)
- August is Immunization Awareness Month (CMS Message 200908-10)
- Upcoming Health Insurance Portability and Accountability Act (HIPAA) Version 5010 Conference Call for Billing Software Vendors and Clearinghouses (JSM09385)
- Delay in Implementation of New Provider Contact Center Technology
- The following ICD-10-CM/PCS publications are now available from the Centers for Medicare & Medicaid Services Medicare Learning Network:
- ICD-10-CM/PCS Myths & Facts (June 2009), which presents correct information in response to some myths regarding the ICD-10-Clinical Modification/Procedure Coding System, is now available in print format. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
- ICD-10-CM-PCS Bookmark (revised August 2009), which provides information about the ICD-10-Clinical Modification/Procedure Coding System including the benefits of adopting the coding system, recommended steps to be taken in order to plan and prepare for implementation of the coding system, and where additional information about the coding system can be found, is now available in downloadable format at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10ClinModBookmrk.pdf
- MM6571 - Program Instructions Designating the Competitive Bidding Areas and Product Categories Included in the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Round One Rebid in calendar year (CY) 2009. This article identifies the nine metropolitan statistical areas (MSAs) as well as product categories in which the DMEPOS competitive bidding round one re-bid will occur in CY 2009 under section 1847 of the Social Security Act. You can view this article at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6571.pdf (CMS Message 200908-09)
- SE0914 - Guidance on Using Internet-based Provider Enrollment, Chain and Ownership System (PECOS). This article provides guidance and reaches out to assist those providers and suppliers who wish to use Internet-based PECOS for enrollment in Medicare and/or to maintain the currency of the enrollment data they have on file with Medicare. You can view this article at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0914.pdf (CMS Message 200908-09)
- Medicare Prescription Drug Plan Premiums To Increase Slightly Medicare Beneficiaries May Need To Enroll In New Plans(CMS Message 2009-08-13)
- Compliance Standards for Consignment Closets and Stock and Bill Arrangements (MM6528)
13 August 2009
07 August 2009
03 August 2009
July
31 July 2009
30 July 2009
24 July 2009
22 July 2009
17 July 2009
-
Claims Processing Change for Capped Rental Modifiers (KH, KI, and KJ)
- An updated
HCPCS Jurisdiction List (CR6522) is now available
- The 2009
DME MAC Jurisdiction A Symposium Speakers & Exhibitors page has been updated
-
DME MAC A Supplier Manual - Chapters 1 and 8 have been reviewed and updated
-
Medicare Remit Easy Print (MREP) Software Codes Update
Update - The Centers for Medicare & Medicaid Services (CMS) is not providing an updated Codes.ini file with the implementation
of the July 2009 release (CR6453). Due to the timing of when the Codes Committee meets, the list of updated Claim Adjustment
Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) will not be available until after the implementation of the July 2009 release.
Therefore, CMS will provide an updated list of CARCs and RARCs via the Codes.ini file with the implementation of the October 2009 release.
(CMS Message 200907-21)
10 July 2009
-
CERT and You – Issue #1 – July 2009
- The article
Written Inquiries - Response by Telephone has been revised
-
DMEPOS Supplier Accreditation and Surety Bond Requirement Deadlines Coming In October (CMS Message 2009-07-06)
-
New versions of the DME MAC A IVR User Guide are now available.
-
June ACT Call Audio Now available
-
Healthcare Common Procedure Coding System (HCPCS) Quarterly 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 web site at
http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp.
Changes are effective on the date indicated on the update.
(CMS Message 2009-07-06)
-
The publication titled ICD-10-CM/PCS Myths & Facts
(June 2009), which presents correct information in response to some myths regarding the ICD-10-Clinical Modification/Procedure
Coding System, is now available in downloadable format from the Centers for Medicare & Medicaid Services
Medicare Learning Network
http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10Mappingfctsht.pdf
(CMS Message 2009-07-09)
-
The Second in Series: General Equivalence Mappings - ICD-9-CM to and from ICD-10-CM and ICD-10-PCS Fact Sheet
(May 2009), which provides basic information about the General Equivalence Mappings (GEM) including possible users of the GEMs,
why the GEMs are needed, and how the GEMs files are formatted as well as Reimbursement Mappings information, is now available in
print format from the Centers for Medicare & Medicaid Services
Medicare Learning Network. To place your order, visit
http://www.cms.hhs.gov/MLNGenInfo/
, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
(CMS Message 2009-07-09)
-
Take Action Now to Prepare for the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program!
A Special Edition MLN Matters education article identifying steps suppliers should take in preparation for the DMEPOS Competitive Bidding Program to ensure successful bidder registration is available at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0915.pdf
The article highlights specific sections of the CMS-855S, Medicare Enrollment Application, where the accuracy of the Authorized Official information and correspondence mailing address are critical for successful bidder registration. The Centers for Medicare & Medicaid Services (CMS) urges suppliers planning to bid in the 2009 bidding cycle to read this article and make sure their most recent CMS-855S submission is still current and accurate. (CMS Message 2009-07-10)
- The following Fee Schedules have been added:
- July Update to the 2009 Jurisdiction A DME MAC Fee Schedule
- July 2009 Quarterly Average Sales Price Medicare Part B Drug Pricing File
- 3rd Quarter 2009 Oral Anticancer Drug Fees
07 July 2009
02 July 2009
01 July 2009
June
26 June 2009
25 June 2009
19 June 2009
18 June 2009
15 June 2009
12 June 2009
05 June 2009
-
Payment for Maintenance and Servicing of Certain Oxygen Equipment as a Result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008
- CR 6509 RESCINDS AND FULLY REPLACES CR 6404
(MM6509)
-
Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
(MM6453)
- The article
Discontinuance of the Unique Physician Identification Number (UPIN) Registry
(MM5584) has been revised
- The article
Influenza Pandemic Emergency - The Medicare Program Prepares
(SE0836) has been revised
-
2009 Fees for Repair or Nonroutine Service for Durable Medical Equipment (DME)
(JSM09213)
-
REMINDER: CMS to Host First National Medicare Fee-For-Service (FFS) Provider Education Call on HIPAA Version 5010 - June 9, 2009
(CMS Message 2009-06-03)
-
Roll-out: Medicare Competitive Bidding Program for DMEPOS, Round One Rebid
(CMS Message 2009-05-29)
-
GET READY FOR COMPETITIVE BIDDING!
(CMS Message 2009-05-29)
-
Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
(CR6453)
-
The Second in Series: General Equivalence Mappings – ICD-9-CM to and from ICD-10-CM and ICD-10-PCS Fact Sheet
(May 2009), which provides basic information about the General Equivalence Mappings (GEM) including possible users of the GEMs,
why the GEMs are needed, and how the GEMs files are formatted as well as Reimbursement Mappings information, is now available in
downloadable format from the Centers for Medicare & Medicaid Services
Medicare Learning Network at
http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10Mappingfctsht.pdf
04 June 2009
01 June 2009
May
29 May 2009
27 May 2009
26 May 2009
-
DME MAC Jurisdiction A is excited to introduce 3 new
Self-Service Tools.
These Self-Service Tools are available to help with common calculations that may be necessary when making billing decisions on Medicare claims.
Our new tools include:
- An Enteral Nutrition Units of Service Calculator
- A Five Year Useful Lifetime Calculator
- A Reconsideration Request Calculator
22 May 2009
15 May 2009
08 May 2009
- New from the Medicare Learning Network (MLN): The Centers for Medicare & Medicaid Services (CMS) Releases a New MLN Matters Article of Particular Interest - SE0904 - An Introductory Overview of the HIPAA 5010 The implementation of HIPAA 5010 presents substantial changes in the content of the data that providers submit with their claims, as well as the data available to them in response to their electronic inquiries. This Special Edition MLN Matters article alerts providers of these HIPAA changes and how they need to plan for their implementation. (CMS Message 2009-05-05)
- General Equivalence Mappings - ICD-9-CM to and from ICD-10-CM and ICD-10-PCS (Fact Sheet): The General Equivalence Mappings - ICD-9-CM To and From ICD-10-CM and ICD-10-PCS (Fact Sheet) (March 2009), which provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) codes to International Classification of Diseases, 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page” (CMS Message 2009-05-05)
07 May 2009
01 May 2009
April
28 April 2009
23 April 2009
17 April 2009
14 April 2009
- The following Fee Schedules have been added:
- April 2009 Quarterly Average Sales Price Medicare Part B Drug Pricing File
- 2nd Quarter 2009 Oral Anticancer Drug Fees
- The following Fee Schedules have been revised:
- January 2009 Quarterly Average Sales Price Medicare Part B Drug Pricing File
- April 2008 Quarterly Average Sales Price Medicare Part B Drug Pricing File
- 1st Quarter 2009 Oral Anticancer Drug Fees
10 April 2009
09 April 2009
06 April 2009
03 April 2009
01 April 2009
March
27 March 2009
26 March 2009
24 March 2009
- DME MAC Jurisdiction A is excited to introduce the new
Self-Service Tools
section of our Web site. These Self-Service Tools are available
to help with common calculations that may be necessary when making billing
decisions on Medicare claims. Our current tool set includes:
-
A Claim Filing Calculator
-
A Redetermination Request Calculator
-
A Capped Rental 13th Month Calculator
-
An Oxygen Rental 36th Month Calculator
Additional tools will be available in the future.
20 March 2009
19 March 2009
13 March 2009
06 March 2009
05 March 2009
February
27 February 2009
26 February 2009
20 February 2009
-
Payment for Repair, Maintenance and Servicing of Oxygen Equipment as a Result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008
(MM6296)
-
ViPs Medicare Systems (VMS) Modifications to Implement the Common Electronic Data Interchange (CEDI) System, Final Implementation
(MM6357)
- The article
Implementation of New Provider Authentication Requirements for Medicare Contractor Provider Telephone and Written Inquiries
(MM6139) has been revised.
-
Oxygen - Certificates of Medical Necessity - Replacement Equipment
-
Medicare Fee-for-Service Provider/Supplier Web Pages Bookmark - A bookmark is available for all
Medicare Fee-for-Service (FFS) providers and suppliers and their staff to use as a one-stop resource
for the Medicare FFS provider and supplier Web pages available on the CMS Web site. This bookmark tells
you how to get to the Web page with the download that allows you to access and peruse all the Medicare
FFS Web pages available. You can stay abreast of policy and operational updates to FFS initiatives from
the CMS Web site. This bookmark is available at the MLN Product Ordering page. To order free of charge,
visit
, http://www.cms.hhs.gov/MLNProducts/80_FFS_Provider_Web_Pages.asp
scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.” The format is an Educational Tool.
(CMS Message 2009-02-13)
-
Medicare DMEPOS Competitive Bidding Program Announcement - The Centers for Medicare & Medicaid Services
has delayed the effective date for the Interim Final Rule with Comment Period that implements certain
provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for the Round 1
Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive
Acquisition Program. The effective date was originally February 17, 2009 and is now April 18, 2009. The
original comment period on the Interim Final Rule remains unchanged. The public has until March 17, 2009,
to submit comments on the substantive policy issues discussed in the rule.
Visit the CMS Web site at
http://www.cms.hhs.gov/DMEPOSCompetitiveBid/
to view additional information.
(CMS Message 2009-02-16)
13 February 2009
-
Due to an overwhelming registration volume, the DME MAC A Outreach & Education Team has scheduled
additional webinar sessions for Oxygen and Oxygen Equipment Billing and Troubleshooting Claim Submission
Errors (CSEs) and Denials. The additional dates are March 6th and March 25th. Please visit the
Events and Seminars
section to register for these sessions.
-
Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Updates (CR6336)
-
The latest Claim Adjustment Reason Codes and Remittance Advice Remark Codes are available in the
Codes.ini file for the MREP software. You can access this file in the Zipped folder for “Medicare
Remit Easy Print - Version 2.5” at
http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp
on the CMS website. (CMS Message 2009-02-10)
-
Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers, and Billers
(October 2008) is now available to download from the CMS Medicare Learning Network (MLN). This publication
is designed to help fee-for-service Medicare providers understand the remittance advice (RA), its applicable
uses, and how to interpret RA fields and codes communicated by Medicare contractors. To view, download
and print this guide, please go to the CMS Medicare Learning Network (MLN) at
http://www.cms.hhs.gov/MLNProducts/downloads/RA_Guide_Full_03-22-06.pdf.
Print copies will be available in approximately 4 to 6 weeks. (CMS Message 2009-02-10)
06 February 2009
January
31 January 2009
30 January 2009
29 January 2009
23 January 2009
-
1099-MISC Form Information
-
March ACT Call Information Now available - Recent Modifier Additions and Changes (KE, KL, RA, RB, etc.)
-
New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Workers' Compensation Medicare Set-aside Arrangements (WCMSAs), to Stop Conditional Payments (MM5371)
-
Therapeutic Shoes for Diabetics - Physician Documentation Requirements
-
Written Inquiries - Response by Telephone
-
CMS Outlines Foundation to Improving Health Care - Roadmaps Issued to Guide Reform of Health Care System (CMS Message 2009-01-16)
-
Department of Health & Human Services (HHS) Issues Final ICD-10 Code Sets and Updated Electronic Transaction (CMS Message 2009-01-21)
-
Revised Online Education Tutorial - Glucose Monitor Billing
-
CMS has announced that an Interim Final Rule with Comment Period, which implements certain provisions
of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for the Round 1 Rebid of
the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Acquisition
Program, is on display at the Federal Register. CMS has also announced the appointment of new members to serve
on the Program Advisory and Oversight Committee (PAOC) for the DMEPOS competitive bidding program. Visit the
CMS Web site at
http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/
to view the list of PAOC members and for the latest information on the DMEPOS competitive bidding program.
To view the Press Release, please click:
http://www.cms.hhs.gov/apps/media/press_releases.asp
(CMS Message 2009-01-16)
16 January 2009
12 January 2009
09 January 2009
06 January 2009
December
30 December 2008
26 December 2008
19 December 2008
-
New Online Education Tutorial
- Medicare Overpayments and Offsets
-
Instructions for Utilizing 837 Professional Claim Adjustment (CAS) Segments for Medicare Secondary Payer (MSP) Part B Claims
(MM6211)
- The article
2008 Jurisdiction List for Durable Medical Equipment Prosthetics, Orthotics, and Supply (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Codes
(MM6062) has been revised
-
Written Clarification on Medicare for Patients and Providers Act of 2008 (MIPPA)
(CMS Message 2008-12-11)
-
What's New for Medicare Fee-for-Service (FFS) Providers on the CMS Web site
(CMS Message 2008-12-11)
-
The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Part B Drug
and Biological Average Sales Price (ASP) Payment Amounts for January 1, 2009 to March 31, 2009
on the CMS web site at
http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a1_2009aspfiles.asp
The files are located in the “Downloads” section of this web page.
-
The October 2008 version of the Adult Immunizations tri-fold brochure, which provides
fee-for-service health care professionals with an overview of Medicare’s coverage of influenza,
pneumococcal, and hepatitis B vaccines and their administration, is now available to order from
the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN).
To place your order, visit
http://www.cms.hhs.gov/MLNProducts/01_Overview.asp
scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.
- The article Updated Healthcare Provider Taxonomy Code (HPTC) List Codes
Effective October 1, 2008 (CR6190) has been added to the
DME MAC Jurisdiction A Resource Number 10 - December 2008
- Meeting Minutes for the
November 2008 Provider Outreach & Education Advisory Group Meeting are now available
18 December 2008
16 December 2008
-
Test Your Knowledge
- The Advanced Beneficiary Notice of Noncoverage (ABN) Quiz is Now Available
15 December 2008
12 December 2008
05 December 2008
04 December 2008
November
28 November 2008
21 November 2008
14 November 2008
07 November 2008
October
31 October 2008
30 October 2008
24 October 2008
17 October 2008
10 October 2008
09 October 2008
03 October 2008
September
30 September 2008
26 September 2008
19 September 2008
18 September 2008
- The following
Local Coverage Determinations (LCDs) have been revised:
- Lower Limb Prosthesis (L11464)
- High Frequency Chest Wall Oscillation Devices (L12870)
- Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L11528)
- Wheelchair Options and Accessories (L11473)
-
There are 4 new Medical Review Bulletins:
-
There is 1 new Medical Review FAQ:
12 September 2008
05 September 2008
August
22 August 2008
15 August 2008
08 August 2008
01 August 2008
July
25 July 2008
24 July 2008
- The Respiratory Assist Devices (L11504)
Local Coverage Determination (LCD) has been revised
-
There are 2 new Medical Review Bulletins:
18 July 2008
17 July 2008
11 July 2008
03 July 2008
June
27 June 2008
25 June 2008
24 June 2008
20 June 2008
- ATTENTION: ONLY SUBMIT WITH NPI !!!
As of May 23, you are required to send the NPI-Only in ALL provider identifier fields for all
HIPAA and paper transactions where a provider identifier is required. If you send
Medicare a transaction with a Medicare legacy identifier in any of the provider fields, your
claim will be rejected. We continue to see rejections for this reason. Additional
information can be referenced in the article: National Provider Identifier (NPI) News for
Medicare FFS Providers: May 23rd is Days Away - Are you Prepared? (CMS Message 2008-05-15)
-
Payment
for Complex Rehabilitative Power Mobility Device (PMD) Services that Spa
Instructions"> (MM6112)
-
Phase 2 Manual Revisions for the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (MM6119)
-
July 2008 Quarterly Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (MM6101)
-
New "K" Code for Replacement Interface Material (MM6075)
- The article
Phase 1 of Manual Revisions to Reflect Payment Changes for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items as a Result of the DMEPOS Competitive Bidding Program and the Deficit Reduction Act of 2005 (MM5978) has been revised
- The article
Overview of New Medicare Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) - The first in a series of articles on the implementation of this program (SE0805) has been revised
- The article
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Grandfathering, Repair and Replacement, Mail Order Diabetic Supplies and Advance Beneficiary Notices (ABNs) - The second in a series of articles on the new DMEPOS competitive bidding program (SE0806) has been revised
- The article
Important Exceptions and Special Circumstances that Occur under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program - The third in a series of articles on the new DMEPOS competitive bidding program (SE0807) has been revised
- DMEPOS Competitive Bidding Program: Phase II Chapter 36 Manual Installment, CBA Zip Code Files, and Beneficiary Outreach News (CMS Message 2008-06-13)
- There is one new Medical Review FAQ:
- Wheelchair Options and Accessories - Remote Joysticks and Controllers - FAQ
- DMEPOS Competitive Bidding Program Begins July 1, 2008 - Are You Ready? (CMS Message 2008-06-19)
- The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Part B Drug and Biological Average Sales Price (ASP) Payment Amounts for July 1, 2008 to September 30, 2008 on the CMS website at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a_2008aspfiles.asp. The files are located in the “Downloads” section of the web page.
- The Overpayment Refund Form has been revised
- Revised Online Education Tutorial - DME MAC Forms
- Revised Online Education Tutorial - Refractive Lens (Vision) Billing
18 June 2008
16 June 2008
13 June 2008
12 June 2008
- Levalbuterol (JSM08351) - This article has been revised. Look for the
revised version posted on June 16, 2008.
06 June 2008
- Notice of Additional Missing Reports for All DME
MAC Jurisdictions
- DMEPOS Competitive Bidding Program - Reminder:
Upcoming National Provider Call (CMS Message 2008-06-06)
- New DMEPOS Competitive Bidding Program Tip Sheet
for Non-Contract Suppliers (CMS Message 2008-06-06)
- National Provider Identifier (NPI): Medicare
Fee-For-Service Update & Medicare Reminder Regarding Accelerated/Advance Payments (CMS
Message 2008-06-03)
- DMEPOS Competitive Bidding Program - New
Educational Products and Upcoming National Provider Call (CMS Message 2008-06-02)
- Jurisdiction B and C DME MAC Trading Partners
Transition to CEDI Extended
-
Average Sales Price (ASP) Updates (MM5798)
-
Phase 1 of Manual Revisions to Reflect Payment Changes for Durable Medical
Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items as a Result of the DMEPOS
Competitive Bidding Program and the Deficit Reduction Act of 2005 (MM5978)
-
VMS Modifications to Implement the Common Electronic Data Interchange (CEDI)
System - Part II (MM6026)
-
July Quarterly Update for 2008 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule (MM6022)
- The article
Overview of New Medicare Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) - The first in a series of articles on the implementation of this program (SE0805) has been revised
- The article
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Grandfathering, Repair and Replacement, Mail Order Diabetic Supplies and Advanced Beneficiary Notices (ABNs) - The second in a series of articles on the new DMEPOS competitive bidding program (SE0806) has been revised
- The article
Important Exceptions and Special Circumstances that Occur under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program - The third in a series of articles on the new DMEPOS competitive bidding program (SE0807) has been revised
-
The article Additional Information on Reporting a National Provider Identifier (NPI) for Ordering/Referring and Attending/Operating/Other/Service facility for Medicare Claims (MM5890) has been rescinded
- Revised Online Education Tutorial - DMEPOS Payment Categories
- Revised Online Education Tutorial - Supplier File Requirements
- The Centers for Medicare & Medicaid Services (CMS) has issued a Medicare Learning Network (MLN) Matters Special Edition Article # SE0820 entitled ~ “Marketing Rules Reminders for Durable Medical Equipment (DME) Suppliers Including Contract Suppliers under the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program.” This article is now posted on the CMS website at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0820.pdf and can also be found on the DMEPOS Competitive Bid web site at http://www.cms.hhs.gov/DMEPOSCompetitiveBid. Click on the “Provider Educational Products and Resources” tab and scroll down to the “Downloads” section. This article describes the existing marketing rules and prohibitions that apply to all Medicare enrolled DMEPOS Suppliers. (CMS Message 2008-06-06) (SE0820)
05 June 2008
- There are 3 new Medical
Review Bulletins:
- Immunosuppressive Drugs LCD Revision - KX Modifier Requirement Added
- KX Modifier and the Knee Orthoses Local Coverage Determination
- Ostomy Supplies - Billing Clarification
- The Immunosuppressive Drugs
Local Coverage Determination (LCD) has been revised
May
30 May 2008
23 May 2008
16 May 2008
09 May 2008
02 May 2008
April
25 April 2008
23 April 2008
17 April 2008
11 April 2008
- CMS Medicare News - Week Ending April 04, 2008
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Grandfathering, Repair and Replacement, Mail Order Diabetic Supplies and Advanced Beneficiary Notices (ABNs) - The second in a series of articles on the new DMEPOS competitive bidding program (SE0806)
- Pre-Bidding Activities for the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (SE0811)
- National Provider Identifier (NPI): Understanding the Readiness of Other Health Plans, Steps to Facilitate a Smooth Transition to NPI-Only Medicare Billing & More! (CMS Message 2008-04-04)
- Incorrect Allowable for Billing Labor (E1340)
- Updated Healthcare Provider Taxonomy Code (HPTC) List Codes Effective April 1, 2008 (CR5951)
- 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 www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp. Changes are effective on the date indicated on the update.
10 April 2008
04 April 2008
March
28 March 2008
21 March 2008
18 March 2008
14 March 2008
7 March 2008
February
29 February 2008
22 February 2008
15 February 2008
8 February 2008
1 February 2008
January
25 January 2008
18 January 2008
11 January 2008
04 January 2008
December
28 December 2007
21 December 2007
14 December 2007
07 December 2007
November
30 November 2007
21 November 2007
16 November 2007
09 November 2007
02 November 2007
- December ACT Call Information Updated
-
How to Handle the National Provider Identifier (NPI) for Ordering/Referring and
Attending/Operating/Other/Service Facility for Medicare Claims (MM5674)
-
Special “Skilled Nursing Facility” (SNF) Definition Used in Determining Durable Medical Equipment
(DME) Coverage, and in Ending a Benefit Period or “Spell of Illness” (SE0745)
- New and Updated
Frequently Asked Questions (FAQs) are now available
- November is American Diabetes Month (CMS
Message 2007-11-01)
- Web-Based Training Course Now Available from
the Medicare Learning Network (MLN) (CMS Message 2007-10-31)
- Important Reminder about Study of Certain
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items (CMS Message
2007-10-26)
- NPI: Key Dates for Medicare, Clarification
Regarding NPI Requirement on Medicare Institutional Claims & More (CMS Message 2007-10-24)
-
CMS Medicare News
– Week
Ending October 26, 2007
- November Flu Shot Reminder
Flu season is here! Medicare patients give many reasons for not getting their annual flu shot,
including — "It causes the flu"; "I don’t need it"; "It has side effects"; "It’s not effective";
"I didn’t think about it"; "I don’t like needles!" The fact is that every year in the United
States, on average, about 36,000 people die from influenza. Greater than 90 percent of these
deaths occur in individuals 65 years of age and older. You can help your Medicare patients
overcome these odds and their personal barriers through patient education. Talk with your Medicare
patients about the importance of getting their annual flu shot--and don’t forget to immunize
yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your
Flu Shot – Not the Flu. Remember - Influenza vaccination is a covered Part B benefit but the
influenza vaccine is NOT a Part D covered drug. For more information about Medicare’s coverage of
flu vaccine and its administration as well as related educational resources for health care
professions, please go to
http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website.
October
26 October 2007
24 October 2007
19 October 2007
12 October 2007
5 October 2007
-
Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update (MM5721)
-
Reasonable Charge Update for 2008 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, and
Certain Intraocular Lenses (MM5740)
- Preventive Services Brochures for Health Care
Professionals Now Available To Order (CMS Message 2007-10-04)
- Special National Provider Identifier (NPI)
Message to Clearinghouses and Billing Services (CMS Message 2007-10-04)
- Medicare Provider Feedback Town Hall Meeting -
October 16, 2007 (CMS Message 2007-10-01)
- October is National Breast Cancer Awareness
Month (CMS Message 2007-10-02)
- Remittance Advice Remark Code (RARC) and
Claim Adjustment Reason Code (CARC) Updates 10/01/2007
- The CMS Durable Medical Equipment, Prosthetics, Orthotics and Supplies
(DMEPOS) CBIC customer service center will provide new hours of operation beginning
Monday, October 1, 2007. The CBIC customer service center associates will be available
to assist you from 9:00 am EST to 5:30 pm EST, Monday through Friday. In
addition, you may e-mail your questions, comments or issues to cbic.admin@palmettogba.com at any time. (CMS Message
2007-10-01)
- Flu Shot Reminder - Flu Season is upon us! Begin now to take advantage
of each office visit as an opportunity to talk with your patients about the flu virus and their
risks for complications associated with the flu. Encourage them to get their flu shot. It’s their
best defense against combating the flu this season. (Medicare provides coverage of the flu
vaccine without any out-of-pocket costs to the Medicare patient. No deductible or
copayment/coinsurance applies.) And don’t forget, health care professionals need to protect
themselves also. Get Your Flu Shot. – Not the Flu. Remember - Influenza vaccination is a covered
Part B benefit. Note that influenza vaccine is NOT a Part D covered drug. For information about
Medicare’s coverage of flu vaccine and its administration as well as related educational
resources for health care professions, please go to
http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website. (CMS
Message 2007-10-04)
- The following Fee Schedules have been added or
revised:
- October 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File
- July 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File -
Revised 10-01-2007
- April 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File -
Revised 10-01-2007
- January 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File -
Revised 10-01-2007
- 4th Quarter 2007 Update: Oral Anticancer Drug Fees
September
28 September 2007
26 September 2007
20 September 2007
13 September 2007
10 September 2007
7 September 2007
August
31 August 2007
24 August 2007
16 August 2007
August
15 August 2007
10 August 2007
- NHIC, Corp. DME MAC A would like to remind suppliers of the requirement for
use of a KX modifier when billing for a manual wheelchair base. This policy change went into
effect for dates of service on or after 05/01/2007.
Per the Manual Wheelchair Base Local Coverage Determination (LCD), suppliers must add a KX
modifier to the code for the manual wheelchair base only if all of the coverage criteria in the
"Indications and Limitations of Coverage" section of the policy have been met. If the coverage
criteria are not met, the KX modifier must not be used. Please refer to the Tricenturion Web site for the current Manual Wheelchair
Base LCD.
- Introducing the New DME MAC A
Ask-the-Contractor Teleconference (ACT) Web Page
NHIC, Corp. DME MAC A hosts a series of quarterly ACT calls. These calls are the latest
installment of educational efforts designed to support and inform the supplier community by
answering questions that are on your mind.
To supplement these calls, the DME MAC A has constructed a new Web page specific to the ACT
calls. This new Web page is designed to provide you with specific details regarding ACT
participation, including participation instructions, the schedule for the next quarterly call and
encore audio recordings of previous ACT calls. The recordings will be available within 10
business days following the scheduled ACT call.
- Processing Error for Q4093-Q4095 - DME MAC A has identified a
processing error for Albuterol codes Q4093-Q4095. These codes became effective July 1, 2007 and
some claims processed at the incorrect allowable.
This issue has been corrected and any new claims and claims still in process will be paid
appropriately. Claims paid at the incorrect allowable will be identified and reprocessed for the
correct allowable. Suppliers do not need to take any further action.
-
The 2007 Medicare Contractor Provider Satisfaction Survey (MCPSS) Shows Positive Results for
Medicare’s Fee-for-Service Contractors
(SE0733)
-
Medicare’s Implementation of the National Provider Identifier (NPI): The Second in the Series of
Special Edition MLN Matters Articles on NPI-Related Activities
(SE0555) has been revised
-
Claim Status Category Code and Claim Status Code Update
(MM5687)
- NPI: The Importance of Reporting Medicare Legacy Numbers in NPPES (CMS Message 2007-08-08)
- August is National Immunization Awareness Month (CMS Message 2007-08-08)
- Dissemination of Data from the National Plan and Provider Enumeration System (NPPES) to Begin September 4, 2007 (CMS Message 2007-08-06)
- CMS Increases Medicare Payments For Beneficiaries Using Skilled Nursing Facility Care For 2008; Accurate Payments Continue To Ensure Program Efficiency, Quality And Sustainability (CMS Message 2007-08-01)
- CMS Increases Payments To Inpatient Rehabilitation Facilities For Fiscal Year 2008; Accurate Payments Will Continue To Ensure Program Efficiency, Quality And Sustainability (CMS Message 2007-08-01)
- Reminder of the Reasonable Useful Lifetime Guidelines
3 August 2007
July
27 July 2007
20 July 2007
13 July 2007
5 July 2007
June
29 June 2007
22 June 2007
-
BREAKING NEWS: Termination of Old 1500
- Special Medicare Provider Enrollment Open
Door Forum (CMS Message 2007-06-15)
- The June 2007 CERT Newsletter is now
available
- DMEPOS Competitive Bidding Reminder (CMS
Message 2007-06-15)
- The article
Revised HCPCS Codes Relating to Immune Globulin (MM5635) has been revised
- The article
July Quarterly Update for 2007 Durable Medical Equipment, Prosthetics, Orthotics, and
Supplies (DMEPOS) Fee Schedule
(MM5641) has been revised
-
July 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective
July 1, 2007, and Revisions to January 2007, April 2007, and October 2006 Quarterly ASP Medicare
Part B Drug Pricing Files
(MM5646)
-
Medicare Contractor Annual Update of the International Classification of Diseases, Ninth
Revision, Clinical Modification (ICD-9-CM)
(MM5643)
-
CMS Medicare News
– Week Ending June 15, 2007
-
CMS Medicare News
– Week Ending June 08, 2007
15 June 2007
7 June 2007
1 June 2007
- CMS Announces Financial Measures for the
Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive
Bidding Program (CMS Message 2007-05-25)
- CMS Requests Additional Public Comment on the
Revised Advance Beneficiary Notice (ABN) (CMS Message 2007-05-25)
-
CMS Medicare News
– Week Ending May 25, 2007
-
Revisions to the Medicare Claims Processing Manual, Chapter 17, Sections 40 and 100, Regarding
Discarded Drugs and Biologicals and Submission of Claims With the Modifier JW, “Drug Amount
Discarded/Not Administered to Any Patient
(MM5520)
-
Foot Care Coverage Guidelines
(SE0707)
-
Quarterly Update to Medically Unlikely Edits (MUEs), Version 1.2, Effective July 1, 2007
(MM5603)
-
Transitioning the Mandatory Medigap ("Claim-Based") Crossover Process to the Coordination of
Benefits Contractor (COBC)
(MM5601)
May
24 May 2007
17 May 2007
11 May 2007
-
DME MAC A Supplier Manual - Chapter 3 has been revised
-
Ask-the-Contractor Teleconference (ACT) - June 2007
-
CMS Proposes Payment, Policy Changes For Inpatient Rehabilitation
Facilities In Fiscal Year 2008 (CMS Message 2007-05-03)
-
Announcement Regarding Part B Paid Claims that Overlap Non-pay SNF
Claims (CMS Message 2007-05-01)
-
May is Healthy Vision Month
(CMS Message 2007-05-02)
-
May is National Osteoporosis Awareness and Prevention Month
(CMS Message 2007-05-08)
-
Modification to the Model Medicare Redetermination Notice (MRN) (for partly or fully unfavorable
redeterminations) and the Administrative Law Judge (ALJ) Filing Locations Where the Place of
Service Was in Delaware, Kentucky, Puerto Rico, Virginia, &/or the US Virgin Islands.
(MM5554)
- Provider Authentication Requirements for Telephone and Written Inquires during the Medicare FFS National Provider Identifier (NPI) Contingency Plan
(SE0721)
-
The article
Stage 2 Requirements for Use and Editing of National Provider Identifier (NPI) Numbers Received in
Electronic Data Interchange Transactions, via Direct Data Entry Screens or Paper Claim Forms
(MM4023) has been revised
- The article Additional Requirements Necessary to Implement the Revised Health Insurance Claim Form CMS-1500
(MM5060) has been revised
-
The article
Stage 2 National Provider Identifier (NPI) Changes for Transaction 835, and Standard Paper
Remittance Advice, and Changes in Medicare Claims Processing Manual, Chapter 22 - Remittance
Advice
(MM5081) has been revised
-
The article
Disclosure Desk Reference for Provider Contact Centers
(MM5089) has been revised
-
The article
Modification of National Provider Identifier (NPI) Editing Requirements in CR4023 and an
Attachment to CR4320
(MM5229) has been revised
-
The article
Claims Submitted With Only a National Provider Identifier (NPI) During the Stage 2 NPI Transition
Period
(MM5378) has been revised
-
The article
Revisions to Incomplete or Invalid Claims Instructions Necessary to Implement the Revised Health
Insurance Claim Form CMS-1500 (Version 8/05)
(MM5391) has been revised
-
The article
Provider Education for Handling Issues Related to Deceased Providers
(MM5508) has been revised
-
The article
Extension for Acceptance of Form CMS-1500 (12-90)
(MM5568) has been revised
- The article New Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFS) for Claims Processing
(MM5571) has been revised
-
The article
CMS Announces the National Provider Identifier (NPI) Enumerator Contractor and Information on
Obtaining NPIs
(SE0528) has been revised
-
The article
Important Guidance Regarding National Provider Identifier (NPI) Usage in Medicare Claims
(SE0659) has been revised
- The article Common Billing Errors to Avoid when Billing Medicare Carriers
(SE0712) has been revised
3 May 2007
April
26 April 2007
24 April 2007
20 April 2007
12 April 2007
6 April 2007
March
30 March 2007
26 March 2007
23 March 2007
22 March 2007
15 March 2007
8 March 2007
1 March 2007
February
27 February 2007
22 February 2007
15 February 2007
08 February 2007
01 February 2007
January
31 January 2007
25 January 2007
- The following Fee Schedules have been added or revised:
- January 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File
- 1st Quarter 2007 Update: Oral Anticancer Drug Fees
- October 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File Revised 01-01-2007
18 January 2007
16 January 2007
11 January 2007
4 January 2007
December
29 December 2006
28 December 2006
21 December 2006
14 December 2006
8 December 2006
-
The DME MAC A Redetermination (781-741-3118) and Reopening (781-741-3914) fax lines will be taken down at noon on Friday December 15, 2006 and will not be available again until Monday December 18, 2006. The Process Control area in Hingham, Massachusetts will be changing offices over the weekend, and the DME MAC is requesting that suppliers not fax submissions over the weekend.
In addition, DME MAC A would like to remind suppliers to use only one avenue when submitting these types of requests. Duplicate submissions being faxed and then received via the postal service slow down the response rate to all requests.
7 December 2006
1 December 2006
November
30 November 2006
22 November 2006
14 November 2006
9 November 2006
6 November 2006
2 November 2006
October
26 October 2006
- This Instruction has been revised: Electronic Data Interchange (EDI) Media Changes (CR5225)
- Communications Infrastructure Testing (CR5336)
- This article has been revised: Additional Requirements Necessary to Implement the Revised Health Insurance Claim Form CMS-1500 (CR5060)
- NPI News Update (CMS Message
200610-23)
- The following Fee Schedules have been added or revised:
4th Quarter 2006 DMEPOS/PEN Fee Schedule - New
3rd Quarter 2006 DMEPOS/PEN Fee Schedule - Revised
2nd Quarter 2006 DMEPOS/PEN Fee Schedule - Revised
1st Quarter 2006 DMEPOS/PEN Fee Schedule - Revised
4th Quarter 2005 DMEPOS/PEN Fee Schedule - Revised
1st Quarter 2005 DMEPOS/PEN Fee Schedule - Revised
October 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File - New
July 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File - Revised
April 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File - Revised
4th Quarter 2006 Update: Oral Anticancer Drug Fees - New
3rd Quarter 2006 Update: Oral Anticancer Drug Fees - Revised
2nd Quarter 2006 Update: Oral Anticancer Drug Fees - Revised
19 October 2006
- New Durable Medical Equipment Prosthetic, Orthotics, and Supplies (DMEPOS) Transcutaneous Electrical Nerve Stimulators (TENS) Certificate of Medical Necessity (CMN) for Purchases (CR5107)
- Electronic Data Interchange (EDI) Media Changes (CR5225)
- 9/26 NPI Roundtable Transcript Available Now - The transcript for the 9/26 NPI Roundtable can be found at http://www.cms.hhs.gov/EducationMaterials/Downloads/NationalProviderIdentifierRoundtable.pdf on the CMS website.
NPI Training Package Available - Now modules for General Information, Electronic File Interchange (EFI), Subparts, and Medicare Implementation are available, and can be found at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPI_Training_Package.pdf on the CMS NPI Page.
October 25th WEDI Audiocast - Registration is open for the WEDI audiocast "NPI 101 - And We're Off! Getting Up To Speed On NPI" to be held on October 25th from 2-3:30 p.m. EST. Learn more about this audiocast, and how to register, at http://www.wedi.org/npioi/index.shtml on the WEDI website. Please note - there is a cost to participate in this audiocast.
- CMS will be administering the
2007 Medicare Contractor Provider Satisfaction Survey (MCPSS) beginning in January 2007. The MCPSS is designed to measure provider satisfaction with and perceptions about the services provided to Medicare providers and suppliers. All FIs, RHHIs, Carriers, DMERCs, DME MACs and the A/B MAC will be included as Fee-for-Service (FFS) Contractors in the national administration of the survey. (JSM07009)
12 October 2006
6 October 2006
3 October 2006
September
29 September 2006
28 September 2006
25 September 2006
- DME MAC Jurisdiction A Resource Number 1 September 2006 is now available
- September 24 -30 is National Adult Immunization Awareness Week. This annual heath observance provides an excellent reminder for you to talk with your Medicare Beneficiaries about vaccine-preventable diseases and ensure that they are protected against influenza and pneumonia, which together are the fifth leading cause of death among adults 65 and older in the U.S. These vaccines are safe and effective, and there are no out-of-pocket costs for your Medicare Beneficiaries. CMS needs your help to ensure that Medicare Beneficiaries take full advantage of these preventive benefits. For information about National Adult Immunization Awareness Week, go to http://www.cdc.gov/nip/events/naiaw/default.htm. For information about Medicare's coverage of adult immunizations and educational resources, go to (http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf). (CMS Message 200609-22)
22 September 2006
21 September 2006
19 September 2006
15 September 2006
14 September 2006
08 September 2006
07 September 2006
- Informative letter about the NHIC contingency plan supporting Electronic Medicare Claims (EMC) transmissions for the DME MAC Jurisdiction A , effective October 1, 2006. – This document is no longer available
-
Tricenturion, the PSC for Jurisdiction A, issued the following bulletins
on 9/5/06:
- Certificates of Medical
Necessity- Revision
- Glucose Monitors-
Documentation Requirements
- Maternity Support
Garments
- Oxygen Policy Revision
- Surgical Dressings-
Revised Coding Guidelines
You can access these
bulletins through this link:
http://www.tricenturion.com/content/currentbulletin_dyn.cfm
- The new version of DMECS has gone live on the SADMERC web site - DMECS is no longer available on the SADMERC Web site.
- The following Fee Schedules have been added or revised:
- July 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File
- April 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File
- January 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File
- 3rd Quarter 2006 Update: Oral Anticancer Drug Fees
- 2nd Quarter 2006 Update: Oral Anticancer Drug Fees
- 1st Quarter 2006 Update: Oral Anticancer Drug Fees
August
31 August 2006
- Update for Crossover
Claims for Medicaids that Did Not Yet Transition to COBA: This
update is to advise that all remaining Medicaid agencies moved to COBA
production as of 7/31/06 with the exception of California, Arizona,
Hawaii, and Maine. We have been advised that Maine will move to COBA
production as of 9/4/06. – This document is no longer available.
- The 3rd Quarter 2006
Update: Oral Anticancer Drug Fees were posted.
- This article
provides a one-time notification to DMERCs with a revised
National Council for Prescription Drug Programs (NCPDP) companion
document. (CR 5080)
- The updates have been posted for
the Health Care Remittance Advice Remark Codes (RARCs) and the
Health Care Claim Adjustment
Reason codes (CARCs).
(CR 5212)
- This article
has been revised:
Evidence of Medical Necessity: Wheelchair and Power Operated Vehicle
(POV) Claims (CR 5128)
- CMS
NPI Roundtable – September 26, 2006
CMS will host a national NPI Roundtable, open to all health care
professionals, on Tuesday, September 26th from 2:00-3:30PM
ET. To participate, you may call
1-877-203-0044, pass code 4795739
CMS will address common questions related to Medicare’s guidance on
Subparts. While CMS will only address questions from a Medicare
perspective, this information may be helpful to all providers. Medicare providers, who have
questions, should select the appropriate email below and send in
questions by Friday, September 8th. Questions received after
this date will not be considered.
Medicare providers who bill a
Fiscal Intermediary should send questions to:
NPIQuestionsfromFIBillers@cms.hhs.gov
Medicare providers who bill a Carrier should send questions to:
NPIQuestionsfromCarrierBillers@cms.hhs.gov
Medicare providers who bill a Durable Medical Equipment Regional Carrier
(DMERC) should send questions to:
NPIQuestionsfromDMERCBillers@cms.hhs.gov
Revised Date for Acceptance of
NPIs on Paper Claims
As mentioned in a previous announcement, Medicare will require the use
of the NPI on paper claims. As such, CMS is implementing use of the
revised CMS-1500 form to accommodate use of the NPI. Transition to the
new form will begin on January 2, 2007. For more details, and to learn
more about the revised form, visit
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5060.pdf
on the CMS website. (CMS Message 200608-13)
- This message is
a reminder for all providers and physicians who bill Medicare
contractors for their services.
A brief
hold will be placed on Medicare payments for all claims during the
last 9 days of the Federal fiscal year (September 22 through
September 30, 2006). These payment delays are mandated by section
5203 of the Deficit Reduction Act of 2005. No interest will be
accrued and no late penalties will be paid to an entity or
individual by reason of this one-time hold on payments. All claims
held during this time will be paid on October 2, 2006.
This
policy only applies to claims subject to payment. It does not apply
to full denials, no-pay claims, and other non-claim payments such as
periodic interim payments, home health requests for anticipated
payments, and cost report settlements.
- CMS has revised this article for a second time: Collection of fee-for-service payments made during periods of managed care enrollment. (CR 5105)
- CMS has revised the article on the changes to the CMS-1500 (12-90) claim form. The intent of the new form is to best accommodate the NPI with minimal changes to the current claim form. (CR 4293)
- CMS has revised the article on Stage 2 requirements for use and editing of National Provider Identifier (NPI) numbers. (CR 4023)
- CMS has revised the article on new Durable Medical Equipment Prosthetic, Orthotics & Supplies (DMEPOS) Certificates of Medical Necessity (CMNs) and DME Medicare Administrative Contractor (MAC) Information Forms (DIFS) for Claims Processing. (CR 4296)
- This article corrects certain business requirements that relate to edits for National Provider Identifiers (NPIs) and provider legacy identifiers when reported on claims, particularly for referring/ordering or other secondary providers, effective October 1, 2006 and later. (CR 5229)
24 August 2006
- The
July edition of the CERT
newsletter has been
posted.
-
This article
instructs your Medicare carrier to provide information for those
providers identified in electronic claims, such as a billing, pay-to,
rendering or other provider,
that have already obtained NPIs. Prior to May 23, 2007, providers
should report the Medicare legacy identifiers of those providers
enrolled to submit claims to Medicare, as well as their NPI. (CR 5217)
-
CMS has
published an article about a
correction to Skilled Nursing
Facility (SNF) Consolidated Billing (CB)coding file.
(CR 5103)
-
CMA has updated Chapter
24 -
National Council for Prescription Drug Program
(NCPDP) Narrative Portion of Prior Authorization Segment. (CR 5092)
-
This article assists physicians, providers, other prescribers, and
pharmacists to understand the CMS’ recommended approach to simplifying
and expediting the
coverage determination process for Medicare Part B versus Part D.
(SE0652)
- This article clarifies for
providers the information issued by the Centers for Medicare & Medicaid
(CMS) regarding the
date to end the contingency plan for ERAs. (SE0656)
- CMS Reminder:
Medicare provides
coverage for diabetes screening tests for eligible Medicare
beneficiaries (SE0660)
- CMS article
on important guidance regarding
National Provider Identifier (NPI) usage in Medicare claims.
(SE0659)
-
If you
applied for a waiver allowing for the receipt of both the electronic
remittance advice (ERA) and standard paper remittance advice (SPR),
please note that this waiver extension ends on October 1, 2006. For more
information, please refer to
MLN Matters article SE0627
on the CMS website.(JSM06586)
- NPI: Get It. Share It. Use It.
August 23rd marks 9
months remaining until the National Provider Identifier (NPI) compliance
date. Over 1 million NPIs have been issued so far --- do you have your
NPI yet? At this 9-month mark, the Centers for Medicare & Medicaid
Services (CMS) would like to announce the following:
CMS NPI Roundtable –
September 26, 2006. (CMS Message 200608-10)
- The new Power Mobility Devices policy has been released. The new policy
is effective for claims with dates of service on or after October 1,
2006. It includes the 64 new codes for POVs and power wheelchairs. You
can view the new policy and the associated bulletin (posted 8/15/06 on
the TriCenturion website) at http://www.tricenturion.com/index.cfm
- TriCenturion, the PSC contractor
issued a bulletin on 8/16/06:
ADVANCED DETERMINATION OF
MEDICARE COVERAGE (ADMC) COVERSHEET UPDATED
The AMDC Coversheet published in
May 2006 has been revised to include additional information necessary to
complete request assessment. Use this sheet for both mailed and faxed
requests. Please discontinue use of the previous coversheet. Requests
may either be mailed or sent by fax. ADMC requests cannot be submitted
electronically. Additional information about documentation requirements
for ADMC requests can be found in the article “Advance
Determination of Medicare Coverage – Wheelchairs”
published in July 2006. You can
access this bulletin on the TriCenturion website in the
Bulletins-Current section at:
http://www.tricenturion.com/content/reg_ab_dme_psc_toc.cfm
- CMS haspublished new quality standards for suppliers of Durable Medical
Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Issuing these
new quality standards is an important step in our ongoing efforts to
ensure that Medicare beneficiaries receive quality healthcare services.
Section 302(a) (1) of the Medicare Modernization Act (MMA) requires the
Secretary to establish and implement quality standards for suppliers to
be applied by recognized independent accreditation organizations.
Suppliers must comply with the quality standards in order to furnish any
Durable Medical Equipment (DME), prosthetic device, prosthetic, or
orthotic item or service for which Part B makes payment, and also in
order to receive or retain a provider or supplier billing number used to
submit claims for reimbursement for any such item or service for which
payment can be made by Medicare. These
new quality standards are located at:
http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/04_New_Quality_Standards.asp
22 August 2006
17 August 2006
-
This
article updates
Indian Health Service Information
(CR 5230).
-
The website wheel has been updated and is now available for order
through the Medicare Learning Network website at
www.cms.hhs.gov/MLNProducts.
(CMS Message 200608-06)
- A New Provider Education Product- Quick Reference Information:
Medicare Immunization Billing- This two-sided job aid gives
Medicare fee-for-service physicians, providers, suppliers, and other
health care professionals quick information to assist with filing claims
for the influenza, pneumococcal, and hepatitis B vaccines and their
administration. This product is available to view, download, and print
from the CMS Medicare Learning Network Preventive Services Educational
Products web page located at
http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp on the CMS website. Print copies will be available in early
Fall, 2006. (CMS Message 200608-05)
-
There is a new EDI page
available on the
Front End Transition. - This document is no longer available.
- NHIC is pleased to announce that Redetermination requests may now be faxed to 781-741-3118.
As noted in the Forms section of the website, you may use this cover sheet when submitting written requests for claim Redeterminations: Request for Redetermination Form (this link goes to the CMS website).
10 Aug 2006
- Due to the
delay in the implementation of a common DME MAC EDI Front End system,
The Centers for Medicare and Medicaid (CMS) has selected
NHIC to implement a
contingency plan supporting Electronic Medicare Claims (EMC)
transmissions for the DME MAC Jurisdiction A , effective October 1,
2006.
-
-
NHIC Medicare B is pleased to announce we will be holding our
third Medicare Fair.
- NPI:
Get It. Share It. Use It.
As the industry transitions to
NPI compliance,
remember that there is no charge to get an NPI. (CMS Message 200607-15)
- Medicare announces
disaster response plan for
individuals with kidney failure.
(CMS Message 200607-14)
- Information on the planned
release of a request for information concerning the next
Medicare Administrative Contractor
(MAC) procurements. (CMS Message 200608-03)
- CMS has some
Preventive Services
Web-Based Training Courses and Appeals Brochure
available. (CMS Message 200608-04)
- Countdown has begun; do you have
your NPI? Don’t risk disruption to your cash flow – Get your NPI now!
National Provider Identifiers (NPIs) will be required on claims sent on
or after May 23, 2007. Every healthcare provider needs to get an NPI!
Learn more about NPI and how to apply by visiting
www.cms.hhs.gov/NationalProvIdentStand/
on the CMS website.
This page also contains a section for Medicare Fee-For-Service (FFS)
providers with helpful information on the Medicare NPI implementation. A
Countdown Clock is now available on this page to remind health care
providers of the number of days left before the compliance date;
bookmark this page as new information and resources will continue to be
posted. For more information on private industry NPI outreach, visit the
Workgroup for Electronic Data Interchange (WEDI) NPI Outreach Initiative
website at
http://www.wedi.org/npioi/index.shtml
on the web. (JSM06468)
- This article discusses a new and more convenient web address and site that houses toll-free numbers that physicians, providers, and suppliers can use to contact their Medicare contractor (carriers including durable medical equipment (DME) regional carriers and DME Medicare administrative contractors (DME MACs), and fiscal intermediaries, including regional home health intermediaries (RHHIs). (SE 0655)
- Do you want up-to-date information from CMS? Then you should review the CMS Mailing Lists Fact Sheet available from the MLN Matters website. The fact sheet can be obtained by downloading it from the following url: http://www.cms.hhs.gov/MLNProducts/downloads/MailingLists_FactSheet.pdf.
Hardcopies can also be ordered by going to the MLN Products Ordering Page at:
http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 and then click on the first item under 'Informational Resource s'. NHIC encourages providers to distribute the mailing lists at all association meetings and events. (JSM06504)
07 Aug 2006
03 Aug 2006
-
The latest version (4.3.0) of ExpressPlus software for submitting claims
to the Jurisdiction A DME MAC (NHIC) is
now available. The use of all other versions of ExpressPlus must be
discontinued immediately.
-
We have added overview information on the EFT Enrollment.
-
The IVR Guide has been
updated. Please use this updated version in your office. This update
contains updated main Menu instructions for Telephone Reopenings:
After the greeting you will hear the
main menu options.
The final option on the IVR is the
option to request a reopening. Press 5 to speak to a CSR about a
reopening. For all other issues, please refer to the main menu.
Please be sure to have all of your information ready to present to
the CSR. Please note, this line is exclusively dedicated to
reopenings in order to serve you in a more timely fashion.
1 August 2006
-
NPI ALERT! The National Plan and Provider Enumeration System (NPPES) will be down for scheduled maintenance on August 2nd and 3rd, and will return to operation on August 4th after 8:00 a.m., Eastern Time. (CMS Message 200607-12)
July
27 July 2006
24 July 2006
20 July 2006
-
National Council for
Prescription Drug Program (NCPDP) Coordination of Benefits (COB)
Workaround Instructions (CR 4290)
- Effective July
19, 2006 the Medicare interest rate for
overpayments and underpayments has been changed to 12.625 percent.
Historical
Data available . (CR 4076)
- Visit
http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp#TopOfPageand scroll to the
bottom of the page to download the Beneficiary Fact Sheet for the
Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals.
Physicians who elect to participate in the CAP are required to provide
the CAP Beneficiary Fact Sheet to Medicare beneficiaries who are
receiving certain Part B physician-administered drugs. (JSM06475)
- Announcing the redesigned CMS web page dedicated
to providing all the latest NPI news for health care providers! Visit
http://www.cms.hhs.gov/NationalProvIdentStand/on the web. This page also contains a section for Medicare
Fee-For-Service (FFS) providers with helpful information on the Medicare
NPI implementation. A new fact sheet with answers to questions that
health care providers may have regarding the NPI is now available on the
web page; bookmark this page as new information and resources will
continue to be posted.
For more information on private industry NPI outreach,
visit the Workgroup for Electronic Data Interchange (WEDI) NPI Outreach
Initiative website at
http://www.wedi.org/npioi/index.shtml on the web. (JSM06184)
- The PSC for DME
MAC Jurisdiction A posted two important bulletins on 7/13/2006:
- Advance
Determination of Medicare Coverage – Wheelchairs
- Power
Mobility Devices – Documentation Requirements
The link to
TriCenturion's web page follows:
http://www.tricenturion.com/index.cfm
Please join
TriCenturion's list serv using this same link to ensure that you receive
all bulletins and announcements from the PSC (Program Safeguard
Contractor). Thank you
- The
Centers for Medicare and Medicaid Services (CMS) has established
a dedicated National Provider Identifier webpage that houses all
NPI outreach information that CMS has prepared, as well as links
to other NPI-related documents of interest to health care
providers. The page also has information that is explicitly for
use by Medicare enrolled providers so that Medicare's
implementation information and expectations are available to
enrolled providers (http://www.cms.hhs.gov/NationalProvIdentStand)
CMS posted a document entitled, "MEDICARE
EXPECTATIONS ON DETERMINATION OF SUBPARTS BY MEDICARE
ORGANIZATION HEALTH CARE PROVIDERS WHO ARE COVERED ENTITIES
UNDER HIPAA"
on the NPI webpage at
(http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Medsubparts01252006.pdf).
This document addresses Medicare organization health care
providers (Entity Type 2) who must determine if they have
subparts that need to be uniquely identified in standard
transactions (e.g., electronic claims transactions) with
Medicare. This document
does not
address health care providers who are enrolled in Medicare as
individual practitioners (such as physicians, physician
assistants, nurse practitioners, and others, including health
care providers who are sole proprietors). In terms of NPI
assignment, an Individual is an Entity Type 1 (Individual) and
is eligible for a single NPI. (JSM06536)
- CMS has revised the article on the updated payment allowance limits for Medicare Part B drugs, effective July 1, 2006. (CR 5110)
|
17 July 2006
13 July 2006
- Revised
Article:
Collection of Fee-for-Service
Payments Made During
Periods of Managed
Care Enrollment (Previously
CR2801 Program Memorandum Transmittal AB-03-101) - MANUALIZATION
(MM 5105)
- This message is a reminder for all providers and physicians who bill Medicare contractors for their services.
A brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006). These payment delays are mandated by section 5203 of the Deficit Reduction Act of 2005. No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments. All claims held during this time will be paid on October 2, 2006.
This policy only applies to claims subject to payment. It does not apply to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments, and cost report settlements.
Please note that payments will not be staggered and no advance payments will be allowed during this 9-day hold.
For more information, please view the MLN Matters Article at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047.pdf. (JSM06549)
07 July
2006
06 July 2006
03 July 2006
June
23 June 2006
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