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Self-Service Tools

• Capped Rental 13th Month Calculator - A capped rental item is paid on a monthly rental basis for a maximum of 13 months at which time the ownership transfers to the beneficiary. Enter the initial date the capped rental began (initial date of service) in this calculator to determine the 13th and final billing month for the capped rental item. Note: This calculator only applies to a capped rental item with an initial date of service on or after January 1, 2006. In addition, this calculator does not apply to parenteral nutrition (PEN) pumps, because PEN is not considered to be capped rental DME, but rather is covered under the prosthetic benefit.
  
  
• Claim Filing Calculator - Claims must be submitted in a timely manner. Enter a date of service in this calculator to determine the latest possible date the claim must be submitted by in order to meet the timely filing deadlines. Note: Under the new law, claims for services furnished on or after January 01, 2010, must be filed within one calendar year after the date of service. .
  
  
• Enteral Nutrition Units of Service Calculator - Enteral nutrition units of service are based on the number of calories of nutrients provided to the beneficiary. One unit of service is equivalent to 100 calories. This calculator will determine the maximum number of units allowed based on the information from the DME MAC Information Form. Enter the number of calories prescribed per day and the number of days in the billing period and the calculator will list the maximum number of units billable for that beneficiary. Note: This calculator will list the maximum amount of units billable during the specified time frame. However, suppliers should only submit for the actual quantity of units provided to the beneficiary.
  
  
• Five Year Useful Lifetime Calculator - Useful Lifetime of DME is considered no less than 5 years beginning with the date of delivery of the equipment to the beneficiary, not the actual age of the equipment. Enter the initial date of the DME piece of equipment (Initial Date of Service) into this calculator to determine the 5 year useful lifetime. This calculator will give you the last date of the useful lifetime of the equipment. Note: This calculator only applies to durable medical equipment (DME). Enteral/parenteral pumps are excluded from this calculation.
  
  
• IVR Beneficiary Name to Number Converter - The Interactive Voice Response (IVR) system requires users either speak or key in a numeric format the beneficiary’s name (first initial and last name for keypad entry). This calculator assists in the correct numeric entry of the beneficiary’s name for eligibility and claim status purposes. Enter the beneficiary’s first initial and full last name and the calculator will list the numeric code that must be entered on your telephone keypad that corresponds with the name.
  
  
• Oxygen Rental 36th Month Calculator - Oxygen systems are paid on a monthly rental basis for a maximum of 36 months. The 36-month cap applies to the entire range of equipment, i.e., all HCPCS codes, in each class of oxygen equipment, i.e., stationary and portable oxygen equipment. Enter the initial date the oxygen rental began (initial date of service) in this calculator to determine the 36th and final billing month for the oxygen equipment rental. Note: For situations where the oxygen services initiated prior to January 1, 2006, the 36-month rental period begins with the January 2006 date of service regardless of how many rental months have been paid prior to January 1, 2006.
  
  
• Reconsideration Request Calculator - A Reconsideration request must be made within 180 days from the date of the Redetermination response letter, which is the first level of appeal, otherwise it will be denied as untimely. Enter the date of the Redetermination letter in this calculator to determine the latest possible date that your Reconsideration request must be received in order to meet the 180 day deadline.
  
  
• Redetermination Request Calculator - A redetermination request must be made within 120 days from the date of denial on the Medicare Remittance Advice (RA) otherwise it will be denied as untimely. Enter the date of the RA in this calculator to determine the latest possible date that your redetermination request may be submitted in order to meet the 120 day deadline.
  
  
• Supply Refill and Contact Calculator - Contact with the beneficiary or designee regarding refills must take place no sooner than 14 calendar days prior to the delivery/shipping date. For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the end of usage for the current product. This is regardless of which delivery method is utilized. This calculator will determine the earliest date that the beneficiary can be contacted regarding their refill and the earliest date which a refill can be shipped. For more information regarding the billing of refills review MLN Matters article 7452 titled, “Prospective Billing for Refills of DMEPOS Items Provided on a Recurring Basis” Note: Some DMEPOS items may only be billed at a maximum 30 day supply. Please check the applicable LCD for the item that is being provided to determine the maximum amount of supplies that can be delivered at one time.
  
  

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09/09/2011