|
Effective March 1, 2008, the medical review (MR) not for benefit integrity (BI) functions that were the responsibility of the DME Program Safeguard Contractors (PSCs) were transitioned to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) for all DME MAC Jurisdictions. This transition does not include the PSC Benefit Integrity functions and is only in relation to the transition of the PSC MR not for BI functions.
Due to the transition, the DME MACs assumed full responsibility for the following workload:
- Performance of MR not for BI functions as outlined in MLN Matters article 5765 and the Medicare Program Integrity Manual (PIM), Chapter 5 - Items and Services Having Special DME Review Considerations;
- Comprehensive Error Rate Testing (CERT);
- Local Coverage Determinations (LCDs)
- Advance Determination of Medicare Coverage (ADMC);
- Healthcare Common Procedure Coding System (HCPCS);
- Medical Review not for BI Claim Edits;
- Probe Reviews;
- Supplier Education and
- Medical Review of Claims (not for BI purposes)
Bulletins
Medical Policies (Local Coverage Determinations(LCD))
HCPCS Codes / Modifiers
Benefit Integrity / Fraud
back to top
03/28/2008 |
