Daily CMS NEWS: 2008

Wednesday, December 31, 2008

DME MAC A News for December 31, 2008 - KL Modifier Reminder

NHIC, Corp.DME MAC A ListServe

For Immediate Release

December 31, 2008
KL Modifier ReminderThe KL modifier must be submitted on all claims for diabetic supply codes (A4233, A4234, A4235, A4236, A4253, A4256, A4258, and A4259) that are furnished via *mail order to beneficiaries. The KL modifier is not used with diabetic supply codes that are not delivered to the beneficiary's residence and are obtained from local supplier storefronts.* Mail order is described as diabetic supplies that are ordered remotely (i.e., by phone, email, internet, or mail) and delivered to the beneficiary's residence by common carriers (e.g., U.S. postal service, Federal Express, United Parcel Service ).

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DME MAC A News for December 31, 2008 - DME MAC A Closed for New Year Holiday

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For Immediate Release

December 31, 2008
The NHIC, Corp. DME MAC A Call Center will be closed on
January 1, 2009 for New Year's Day

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DME MAC A News for December 31, 2008 - New KE Modifier Effective January 1, 2009

NHIC, Corp.DME MAC A ListServe

For Immediate Release

December 31, 2008

New KE Modifier Effective January 1, 2009

Suppliers must use the KE modifier to identify when the same accessory HCPCS code can be furnished in multiple competitive and non-competitive bidding product categories. For example, HCPCS code E0981 Wheelchair Accessory, Seat Upholstery, Replacement Only, Each can be used with both competitively bid standard and complex rehabilitative power wheelchairs (K0813 thru K0829 and K0835 thru K0864), as well as with non-competitively bid manual wheelchairs (K0001 thru K0009) or a miscellaneous power wheelchair (K0898). The KE modifier would be appended to the E0981 if it is an accessory for a K0001 manual wheelchair (the non-competitively bid base item).

The KE modifier is used to identify an accessory code that can be dually billed with either a competitive or non-competitive bid base item, the KE modifier must be appended to the accessory code if it is billed with a non-competitively bid base item.

Note:Suppliers should not use the KE modifier on any claims for items that were included under Round 1 of competitive bidding such as an accessory for a standard or complex rehabilitative power wheelchair.

Standard or Complex Rehabilitative Power Mobility Device Accessories

When billing a Column I accessory code for use with a base code in Column II, do not use the KE modifier. When billing a Column I accessory code for use with a base code in Column III, use the KE modifier.

Column I - Accessory

Column II - Power Mobility Device Base
(No KE Modifier)

Column III - Wheelchair Base
(KE Modifier)

E0950, E0951, E0952, E0955, E0956, E0957, E0960, E0973, E0978, E0981, E0982, E0990, E0995, E1016, E1020, E1028, E2208, E2209, E2210, E2361, E2363, E2365, E2366, E2367, E2368, E2369, E2370, E2371, E2381, E2382, E2383, E2384, E2385, E2386, E2387, E2388, E2389, E2390, E2391, E2392, E2394, E2395, E2396, E2601, E2602, E2603, E2604, E2605, E2606, E2607, E2608, E2611, E2612, E2613, E2614, E2615, E2616, E2619, E2620, E2621, K0015, K0017, K0018, K0019, K0020, K0037, K0038, K0039, K0040, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052, K0053, K0098, K0195, K0733, K0734, K0735, K0736, K0737

K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864

K0001, K0002, K0003, K0004, K0005, K0006, K0009, K0830, K0831, K0898, E1050, E1060, E1070, E1083, E1084, E1085, E1086, E1087, E1088, E1089, E1090, E1092, E1093, E1100, E1110, E1130, E1140, E1150, E1160, E1161, E1170, E1171, E1172, E1180, E1190, E1195, E1200, E1220, E1221, E1222, E1223, E1224, E1225, E1226, E1227, E1228, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, E1239, E1240, E1250, E1260, E1270, E1280, E1285, E1290, E1295

Complex Rehabilitative Power Mobility Device Only Accessories

When billing a Column I accessory code used with a base code in Column II, do not use the KE modifier. When billing a Column I accessory code used with a base code in Column III, use the KE modifier.

Column I - Accessory

Column II - Complex Rehab Base
(No KE Modifier)

Column III - Wheelchair Base
(KE Modifier)

E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1010, E1029, E1030, E2310, E2311, E2321, E2322, E2323, E2324, E2325, E2326, E2327, E2328, E2329, E2330, E2351, E2373 KC*, E2374, E2375, E2376, E2377

K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864

* When billing E2373 KC for use with a Column III wheelchair, use the KE modifier in place of the KC pricing modifier.

IV Pole

When billing an IV pole for use with an enteral code in Column II, do not use the KE modifier. Continue to use the BA modifier. When billing the IV pole for use with a parenteral code in Column III, use the KE modifier in place of the BA modifier.

Column I - IV Pole

Column II - Billed with Enteral Nutrition
(No KE, Only BA Modifier)

Column III - Billed with Parenteral Nutrition
(KE Modifier)

E0776 BA

B4149, B4150, B4152, B4153, B4154, B4155

B4164, B4168, B4176, B4178, B4180, B4185, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200

Canister used with Negative Pressure Wound Therapy Pumps

When billing A7000 for use with a negative pressure wound therapy pump in Column II, do not use the KE modifier. When billing A7000 for use with a respiratory or gastric suction pump code in Column III, use the KE modifier.

Column I - Canister

Column II - Billed with NPWT
(No KE Modifier)

Column III - Billed with Suction Pumps
(KE Modifier)

A7000

E2402

E0600, E2000

Walker Replacement Handgrips and Tips

When billing replacement handgrips and tips for use with a walker code in Column II, do not use the KE modifier. When billing replacement handgrips and tips for use with a cane or crutch code in Column III, use the KE modifier.

Column I - Handgrips and Tips

Column II - Billed with Walkers
(No KE Modifier)

Column III - Billed with Canes or Crutches
(KE Modifier)

A4636, A4637

E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149

E0100, E0105, E0110, E1111, E1112, E0114, E0116, E0117, E0118

For information regarding the KE modifier and the 2009 fee schedule please refer to CR6270.

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DME MAC A News for December 31, 2008 - Weekly Updates

NHIC, Corp.DME MAC A ListServe

For Immediate Release

December 31, 2008

Weekly What's New

The following publications have been posted to the DME MAC A What's New page:New KE Modifier Effective January 1, 2009

KL Modifier Reminder

Update on the CEDI Front-End Editing Process

Common Electronic Data Interchange (CEDI) Help Desk Telephone Line Modifications Effective Monday, January 05, 2009

The 2009 HCPCS Codes and Modifiers lists are now available
For more information visit:

http://www.medicarenhic.com/dme/dme_whats_new.shtml

CMS Strengthens Efforts to Fight Medicare Waste, Fraud and Abuse
Medicare Issues Final Rule Requiring Surety Bonds for DMEPOS Suppliers and Takes Next Step in Fighting Home Health Fraud
(CMS Message 2008-12-29)The Centers for Medicare & Medicaid Services (CMS) today announced it is requiring certain durable medical equipment suppliers to post a surety bond. In addition, CMS is announcing that it has revoked the billing privileges of more than 1,100 medical equipment suppliers in south Florida and southern California and suspending payments to home health agencies in the Miami-Dade, Fla. area."We know the majority of medical equipment suppliers and health care providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare," said CMS Acting Administrator Kerry Weems. "The steps we are taking today provide us with additional oversight of the suppliers who furnish medical equipment to Medicare beneficiaries and those who provide home health services in South Florida."CMS today issued a final surety bond regulation, required by the Balanced Budget Act of 1997, that makes certain suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) post a $50,000 surety bond. Existing suppliers must comply with this requirement by Oct. 2, 2009 while newly enrolling suppliers must meet this requirement by May 4, 2009. This requirement was due in part to the large number of improper and potentially fraudulent payments to medical equipment suppliers for furnishing medical equipment and devices to people with Medicare. The 2007 Medicare error rate report found approximately $1 billion in improper payments for medical equipment and supplies.The surety bond requirement is designed to limit the Medicare program risk from fraudulent equipment suppliers and help to ensure that only those suppliers who remain in the program furnish items to Medicare beneficiaries that are considered reasonable and necessary from legitimate DME suppliers.Suppliers who have had certain adverse legal actions imposed against them in the past may also be required to post a higher bond amount. All newly enrolling suppliers that meet the requirements of the rule will be required to have a surety bond before they can enroll in the Medicare program. More information about the new regulation can be found at http://www.cms.hhs.gov/MedicareProviderSupEnrollWhile this regulation requires most suppliers to obtain a surety bond, some companies or organizations that supply these items are exempt from the surety bond requirement, including certain physicians and non-physician practitioners, physical and occupational therapists, state-licensed orthotic and prosthetic personnel, and government-owned suppliers.To prevent fraud, CMS has revoked billing privileges of 1,139 DMEPOS suppliers as part of the DMEPOS High-Risk Suppliers Demonstration. This project began in October 2007 and focuses on DMEPOS suppliers in South Florida and the Los Angeles metropolitan area. These suppliers, who were paid a combined total of $265 million between calendar years 2005 and 2007, lost their billing privileges for not re-enrolling in the Medicare program and not meeting Medicare's supplier standards.CMS is continuing to fight waste, fraud and abuse by home health suppliers in the Dade County, Fla., area by suspending payments and taking other payment and review actions. On Oct. 6, CMS initiated efforts to address potential waste, fraud and abuse by suspending payments to 10 home health agencies and is continuing to review claims and payments to other agencies as resources allow.In addition to suspending payment, CMS is:Implementing extensive pre- and post-payment review of claims submitted by ordering/referring physicians

Validating claims submitted by physicians who order a high number of certain items or services by sending follow-up letters to these physicians;

Verifying the relationship between physicians who order a large number of home health services and the beneficiaries for whom they ordered those services; and

Identifying and visiting high risk beneficiaries to ensure they are appropriately receiving the services for which Medicare is being billed.

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Tuesday, December 30, 2008

DME MAC Jurisdiction C News

http://www.cignagovernmentservices.com/jc/education/webinars.html">The DME MAC Provider Outreach and Education team will conduct an Oxygen Webinar on January 6, 8, and 12, 2009.
http://www.cignagovernmentservices.com/jc/education/webinars.html

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Monday, December 29, 2008

Jurisdiction B News: Surgical Dressings Code A6545

Surgical Dressings - Code A6545 - Billing Instructions - December 2008 Recent revisions to the Local Coverage Determination (LCD) for Surgical Dressings and the related Policy Article were published with an effective date of January 1, 2009. The Policy Article revision neglected to include billing instructions for HCPCS Code A6545. A6545 GRADIENT COMPRESSION WRAP, NON-ELASTIC, BELOW KNEE 30-50 MM HG, EACH Similar to codes A6531 and A6532 (compression stockings) which are addressed in the Policy Article Coding Guidelines section, HCPCS modifiers A1-A9 are not to be used with A6545.

When a gradient compression wrap, A6545, is used for an open venous stasis ulcer, the code must be billed with the AW modifier. If there is no open ulcer, the AW modifier must not be used. Claims for code A6545 without an AW modifier will be denied as statutorily noncovered. The right (RT) and left (LT) modifiers must also be used with this code. When the same code for bilateral items (left and right) is billed on the same date of service, bill both items on the same claim line using LTRT modifiers and 2 units of service. These guidelines will be included in a future revision of the Surgical Dressings medical policy. The only products that may be billed with code A6545 (non-elastic compression wrap) are those which have received a written Coding Verification Review from the Pricing, Data Analysis, and Coding (PDAC) contractor and that are posted in the Product Classification List on the PDAC web site.
Suppliers should refer to the Surgical Dressings LCD and related Policy Article for additional guidance on the coverage, coding and documentation requirements.

Remember! National Government Services' Jurisdiction B DME MAC List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you! CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message.

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EDI News: Claim Status Inquiry (CSI) CBT Now Available

A new Computer-Based Training (CBT) course is now available through the National Government Services Medicare Learning Management System (LMS) at: http://www.ngsmedicare.com/NGSMedicare/DMEMAC/EducationandSupport/ComputerBasedTraining/IndexCompBasedTrainDMEMAC.aspx This training module is designed to explain the benefits of using Claim Status Inquiry (CSI) to locate paper and electronically submitted claims in the Jurisdiction B DME MAC claims processing system and to access Beneficiary Eligibility information via your computer. The step-by-step process shows participating and non-participating suppliers how easy it is to obtain this information. Some of the questions that are answered in this Claim Status Inquiry CBT include: What information can be obtained?How can access be obtained? Who can help if there are any questions? Click on the above link to be taken directly to the Medicare Learning Management System now or visit the Medicare Learning Management System via the Home page of the National Government Services Web site at: www.NGSMedicare.com.

Remember! National Government Services' EDI List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you! CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message.

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EDI News: Total Electronic Environment Course Now Available

The Jurisdiction B DME MAC strives to deliver detailed information through several resources including the Medicare Learning Management System. Now available on the Medicare Learning Management System is the Total Electronic Environment Computer Based Training Course. This computer based training course is an interactive online tutorial, which have been developed to help assist in the dissemination of supplier information. The Total Electronic Environment Computer Based Training Course will provide the benefits associated with using Electronic Remittance Advices and Electronic Funds Transfers to make suppliers' offices more efficient. This will also show how electronic submitters can become totally electronic. To access the Medicare Learning Management System click on or paste the following link into your Internet browser: http://www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/ComputerBasedTraining/IndexCompBasedTrainDMEMAC.aspx

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Jurisdiction B News: Comment Period Instructions for Oxygen Payment Rules

CMS Comment Period Instructions forOxygen Payment Rules and Supplier Responsibilities The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment for the new payment rules and supplier responsibilities required under the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA), in the Revisions to Payment Policies and under the Physician Fee Schedule and Other Revisions to the Part B regulation (CMS-1403-FC). CMS will be issuing detailed program instructions and Medicare Learning Network (MLN) Matters articles related to implementation of payment changes mandated by section 144(b) of MIPPA and section 5101 of the Deficit Reduction Act of 2005 within the next few months. The CMS is accepting comments regarding these changes from all interested parties during the 60 day comment period which is scheduled to term at 5 p.m. EST December 29, 2008. In commenting, please refer to file code CMS-1403-FC. Comments may be submitted by following any of the four options listed below: 1. Electronically - You may submit electronic comments on this regulation to www.regulations.gov. Enter the file code in the search bar, then click "Send a comment or submission", fill in the information required and include the file code in your comments. 2. By regular mail - You may mail written comments to the following address ONLY: CMS-1403-FC 3Centers for Medicare & Medicaid ServicesDepartment of Health and Human ServicesAttention: CMS-1403-FCP.O. Box 8013Baltimore, MD 21244-8013 Allow sufficient time for mailed comments to be received before the close of the comment period. 3. By express or overnight mail - You may send written comments to the following address ONLY: Centers for Medicare & Medicaid ServicesDepartment of Health and Human ServicesAttention: CMS-1403-FCMail Stop C4-26-057500 Security BoulevardBaltimore, MD 21244-1850 4. By hand or courier - If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to either of the following addresses: 7500 Security BoulevardBaltimore, MD 21244-1850 Room 445-GHubert H. Humphrey Building200 Independence Avenue, SWWashington, DC 20201

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CEDI Help Desk Will be Closed on New Year?s Day

All Medicare Part A, Part B, Jurisdiction B DME MAC and CEDI DME MAC Electronic Submitters

National Government Services CEDI Help Desk will be closed for New Year s Day.

In observance of New Year s Day, the National Government Services office will be closed on Thursday, January 1, 2009.

The Part A, Part B, and Jurisdiction B DME MAC EDI Help Desks will reopen on Friday, January 2, 2009 at 8:00 a.m. (ET) for normal business hours.

The CEDI Help Desk will reopen on Friday, January 2, 2009 at 9:00 a.m. (ET) for normal business hours.

Thank you,
National Government Services, Inc.
Corporate Communications

Friday, December 26, 2008

DME MAC A News for December 26, 2008 - Weekly Updates

NHIC, Corp.DME MAC A ListServe

For Immediate Release

December 26, 2008

Weekly What's New

The following publications have been posted to the DME MAC A What's New page:Changes in Payment for Oxygen Equipment as a Result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 and Additional Instructions Regarding Payment for Durable Medical Equipment Prosthetics Orthotics & Supplies (DMEPOS) (MM6297)

January 2009 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (MM6288)

Surgical Dressings Billing Instruction for HCPCS Code A6545

CMS Launches Fourth Annual Medicare Health Care Provider Satisfaction Survey (CMS Message 2008-12-19)
For more information visit:

http://www.medicarenhic.com/dme/dme_whats_new.shtml

This announcement is of special interest to Medicare suppliers.The Centers for Medicare & Medicaid Services (CMS) has issued MLN Matters Article # MM6297 entitled ~ Changes in Payment for Oxygen Equipment as a Result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 and Additional Instructions Regarding Payment for Durable Medical Equipment Prosthetics Orthotics & Supplies (DMEPOS). This article is now posted on the CMS website at:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6297.pdfThis article provides guidance on the changes in payment for oxygen and oxygen equipment as a result of section 144(b) of the MIPPA of 2008, as well as additional claims processing and payment instructions for DMEPOS items.Please be advised that additional billing instructions on this subject will be forthcoming from CMS.

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DME MAC A News for December 26, 2008 - DME MAC A Test Your Knowledge - ABN Quiz Now Available

NHIC, Corp.DME MAC A ListServe

For Immediate Release

December 26, 2008
DME MAC Jurisdiction A Test Your Knowledge - ABN Quiz Now AvailableIn an effort to continue to enhance our educational efforts, DME MAC Jurisdiction A is pleased to announce the addition of a new Test Your Knowledge quiz. The new quiz, Advanced Beneficiary Notice of Noncoverage (ABN), poses questions on the revised ABN. After completing the quiz users will be directed to the correct answers along with a short description of where they can locate more information on the ABN. The results will also be used to detect educational needs among the supplier community and on an individual basis.If you have been billing Medicare for years or are just starting out, stop by the DME MAC A Web site today and Test Your Knowledge! You may qualify for individual, one-on-one education by one of our Outreach Specialists.The new ABN Test Your Knowledge quiz can be found on the DME MAC A Web site at:
http://www.medicarenhic.com/dme/dme_quiz_index.shtml

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DME MAC A News for December 26, 2008 - DME MAC Jurisdiction A Winter Webinar Schedule Reminder

NHIC, Corp.DME MAC A ListServe

For Immediate Release

December 26, 2008
DME MAC Jurisdiction A Winter Webinar ScheduleThe DME MAC Jurisdiction A Outreach & Education Team still has the following FREE educational Webinar sessions open for registration.

All times Eastern StandardJanuary 13, 2009 from 9:30am - 11:30am
DME MAC Essentials I

January 13, 2009 from 1:30pm - 3:30pm
DME MAC Essentials II

January 15, 2009 from 9:30am - 11:30am
Advance Beneficiary Notice of Noncoverage (ABN)

January 15, 2009 from 1:30pm - 3:30pm
Urological Billing

January 20, 2009 from 9:30am - 11:30am
Positive Airway Pressure (PAP) Device Billing

January 20, 2009 from 1:30pm - 3:30pm
Hospital Bed Billing

January 27, 2009 from 9:30am - 11:30am
Urological Billing

January 27, 2009 from 1:30pm - 3:30pm
Advance Beneficiary Notice of Noncoverage (ABN)

January 29, 2009 from 9:30am - 11:30am
DME MAC Essentials I

January 29, 2009 from 1:30pm - 3:30pm
DME MAC Essentials II

February 3, 2009 from 9:30am - 11:30am
Hospital Bed Billing

February 3, 2009 from 1:30pm - 3:30pm
Oxygen and Oxygen Equipment Billing

February 5, 2009 from 9:30am - 11:30am
Advance Beneficiary Notice of Noncoverage (ABN)

February 5, 2009 from 1:30pm - 3:30pm
Positive Airway Pressure (PAP) Device Billing

February 12, 2009 from 9:30am - 11:30am
Troubleshooting Claim Submission Errors (CSEs) and Denials

February 12, 2009 from 1:30pm - 3:30pm
Oxygen and Oxygen Equipment Billing

February 17, 2009 from 9:30am - 11:30am
DME MAC Essentials I

February 17, 2009 from 1:30pm - 3:30pm
DME MAC Essentials II

February 19, 2009 from 9:30am - 11:30am
Urological Billing

February 19, 2009 from 1:30pm - 3:30pm
Hospital Bed Billing

February 24, 2009 from 9:30am - 11:30am
Positive Airway Pressure (PAP) Device Billing

February 24, 2009 from 1:30pm - 3:30pm
Troubleshooting Claim Submission Errors (CSEs) and Denials

February 26, 2009 from 9:30am - 11:30am
Oxygen and Oxygen Equipment Billing

February 26, 2009 from 1:30pm - 3:30pm
Advance Beneficiary Notice of Noncoverage (ABN)

March 10, 2009 from 9:30am - 11:30am
DME MAC Essentials I

March 10, 2009 from 1:30pm - 3:30pm
DME MAC Essentials II

March 12, 2009 from 9:30am - 11:30am
Troubleshooting Claim Submission Errors (CSEs) and Denials

March 12, 2009 from 1:30pm - 3:30pm
Hospital Bed Billing

March 17, 2009 from 9:30am - 11:30am
Positive Airway Pressure (PAP) Device Billing

March 17, 2009 from 1:30pm - 3:30pm
Oxygen and Oxygen Equipment Billing

March 19, 2009 from 9:30am - 11:30am
Advance Beneficiary Notice of Noncoverage (ABN)

March 19, 2009 from 1:30pm - 3:30pm
Urological BillingFor further details please visit the "Events/Seminars" section of the DME MAC A Web site at: http://www.medicarenhic.com/dme/dmerc_seminars.shtml

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Update on the CEDI Front-End Editing Process

National Government Services, Common Electronic Data Interchange (CEDI) is in the process of changing the current front-end editing process for ANSI X12 837 claims and 276 claim status request transactions.

All new edits have been added to the CEDI Front-End Reports Manual. This manual is available on the CEDI Web site at http://www.ngscedi.com/outreach_materials/outreachindex.htm.

Please note the following edits are currently in place at CEDI on the GenResponse (GENRPT) report:

NGS005	C065	C125
NGS006	C072	C131
NGS008	C077	C137
B108	C086	C141
C007	C087	C143
C015	C088	C147
C055	C089	C157
C060	C090

The changes to the front-end editing process will occur in two stages.

Stage 1 - Implementation will begin on Friday, January 9, 2009

On Friday, January 9, 2009 at 3:00 p.m. ET, the CEDI Gateway will be brought down until Sunday, January 11, 2009 at 6:00 p.m. ET to implement the additional CEDI edits.
** During this time, Trading Partners will not be able to connect to CEDI to transmit or receive electronic transactions and/or reports.
The additional front-end edits for 837 claims will be added to the current CEDI GenResponse (GENRPT) report.
837 claims shown as accepted on the GenResponse Report will be delivered to the DME MACs.
Claims delivered to the DME MACs will continue to edit against the DME MAC Level II edits as they do currently.
Claims accepted on the DME MAC Level II reports will be assigned a Claim Control Number (CCN) that will be attached to the claim as it enters the DME MAC for processing.
CEDI will deliver the DME MAC Level II reports to the Trading Partner.
Claims rejected on the DME MAC Level II report must be corrected and resubmitted to CEDI.
837 claims rejected on the GenResponse Report will not be delivered to the DME MACs. These claims must be corrected and resubmitted to CEDI.
Most, if not all, claims that reject will be returned on the GenResponse Report. It will be extremely important for Trading Partners to monitor the GenResponse Report for rejected claims in order to correct and resubmit the claims to CEDI.
The additional CEDI front end edits will be implemented for the 276 claim status request transactions.
276 transactions that reject at CEDI will be reported back on a 277 claim status response.
276 transactions accepted by CEDI will be delivered to the DME MACs.
276 transactions delivered to the DME MACs will continue to edit against the DME MAC Level II edits as they do currently.
276 transactions accepted on the DME MAC Level II reports will be sent to the DME MAC for processing to produce the 277 to report the claim status back to the Trading Partner.

Stage 2 - Implementation will occur on January 30, 2009

On Friday, January 30, 2009 at 3:00 p.m. ET, the CEDI Gateway will be brought down until Sunday, February 1, 2009 at 6:00 p.m. ET for the DME MACs to remove their front end edits for 837 claims and 276 claims status transactions.
** During this time, Trading Partners will not be able to connect to CEDI to transmit or receive electronic transactions and/or reports.
The DME MACs will remove their front end edits and all electronic front-end editing for the X12 837 claims and 276 claim status transactions will be done through CEDI
837 claim front-end rejections will be returned on the CEDI GenResponse (GENRPT) report.
276 claims status request front-end rejections will be returned on the 277 claims status response transaction.
The additional GenResponse edits that were implemented in Stage 1 will replace the DME MAC Level II edits and Trading Partners will no longer receive Level II reports from the DME MACs.
Claims accepted on the GenResponse Report will be assigned a Claim Control Number (CCN) and these will be indicated on a report that will go back to the Trading Partner from CEDI. This CCN will be attached to the claim as it enters the appropriate DME MAC for processing.
All electronic front-end editing for the X12 276 claim status request transaction will be done through CEDI and all front-end rejections will be returned on the 277 transaction.

Note: The CCN assignment changes scheduled for Stage 2 may occur at a later stage. If this occurs, notification will be sent via the CEDI Listserv.

CMN Rejection Report: The process for DME MACs to edit CMNs submitted on the 837 claims will not change. Any CMN rejections will be returned on the CMN Rejection Report produced by the DME MACs and delivered to the Trading Partners CEDI mailbox in the RPT file.

NCPDP Claims: NCPDP claims are not affected by these changes. CEDI will continue to receive the NCPDP claims from the Trading Partner and forward the claims to the DME MACs. The DME MACs will perform all front end editing and assign the Claim Control Number (CCN) to accepted NCPDP claims.

Please contact the CEDI Help Desk at 866-311-9184 or by e-mail at ngs.cedihelpdesk@wellpoint.com if you have questions about the upcoming changes or the CEDI front end edits.

All CEDI Listservs are posted to the News section of the CEDI Web site at http://www.ngscedi.com/news/newsindex.htm.

Thank you,
National Government Services, Inc.
Corporate Communications

National Government Services' Listserv is for outgoing messages only. Please do not respond back to messages as your response will not be answered, this is not an authorized mode of communication at this time. Thank you!

To update your CEDI Listserv profile select Login from the Listserv Registration section of the CEDI Web site.

To unsubscribe from the CEDI Listserv click the following link, http://66.193.191.61/list/unsubscribeList.html?lui=ffblhtkk&mContainer=8&mOwner=G2r372s&mListId=HL%23135.

Wednesday, December 24, 2008

DME MAC Jurisdiction C News

Surgical Dressings Billing Instruction for HCPCS Code A6545: Recent revisions to the Local Coverage Determination (LCD) for Surgical Dressings and the related Policy Article were published with an effective date of January 1, 2009. The Policy Article revision neglected to include billing instructions for HCPCS Code A6545. Read more...
http://www.cignagovernmentservices.com/jc/pubs/news/2008/1208/cope9002.html

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Newly Released MLN Matters Article of Special Interest to Medicare Suppliers

This announcement is of special interest to Medicare suppliers.

The Centers for Medicare & Medicaid Services (CMS) has issued MLN Matters Article # MM6297 entitled ~ "Changes in Payment for Oxygen Equipment as a Result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 and Additional Instructions Regarding Payment for Durable Medical Equipment Prosthetics Orthotics & Supplies (DMEPOS)." This article is now posted on the CMS website at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6297.pdf.

This article provides guidance on the changes in payment for oxygen and oxygen equipment as a result of section 144(b) of the MIPPA of 2008, as well as additional claims processing and payment instructions for DMEPOS items.

Please be advised that additional billing instructions on this subject will be forthcoming from CMS.

____________________________________________________________________________________________

Flu Shot Reminder

It's seasonal flu time again! If you have Medicare patients who haven't yet received their flu shot, you can help them reduce their risk of contracting the seasonal flu and potential complications by recommending an annual influenza and a one-time pneumococcal vaccination. Medicare provides coverage of flu and pneumococcal vaccines and their administration. - And don't forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your FluShot - Not the Flu.

Remember- Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug.

Health care professionals and their staff can learn more about Medicare's coverage of the influenza vaccine and other Medicare Part B covered vaccines and related provider education resources created by CMS, by reviewing Special Edition MLN Matters article SE0838 http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0838.pdf on the CMS website.

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If you received this message as part of the All FFS Providers listserv, you are currently subscribed to one of eighteen Medicare Fee-For-Service provider listservs. If you would like to be removed from all NIH listservs, please go to (https://list.nih.gov/LISTSERV_WEB/signoff.htm) to unsubscribe. If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/show_list_archives) to unsubscribe or to leave the appropriate listserv. Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. Responses to this email are not routed to CMS personnel. Inquiries may be sent by going to (http://www.cms.hhs.gov/ContactCMS). Thank you.

Jurisdiction B News: Electronic Reports & Top Rejections Webinar Materials

National Government Services, the Jurisdiction B DME MAC conducted an Electronic Reports and Top Rejections Webinar on Thursday, December 18, 2008. The following materials are now available on the Web site: PowerPoint Slide Presentation: This is the slide presentation that was used during the Webinar. Jurisdiction B DME MAC Top Rejections for November 2008: This handout was used during the Webinar. Changes to the Electronic Reports Effective January 2009: This handout was used during the Webinar. Presentation Overview: This presentation overview includes a description for each PowerPoint slide. Q&A Document: This Q& A document includes all the questions that were asked verbally during the Webinar and online. To access these materials, click on or paste the following link into your Internet browser: http://www.ngsmedicare.com/NGSMedicare/DMEMAC/EducationandSupport/Webinars/IndexWebinarsDMEMAC.aspx">http://www.ngsmedicare.com/NGSMedicare/DMEMAC/EducationandSupport/Webinars/IndexWebinarsDMEMAC.aspx

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Tuesday, December 23, 2008

Palmetto GBA E-mail Update

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cursor at the start of the broken line where the text is no longer blue.

Then, backspace once. It will join the line to the line above it, making

both lines blue. You may need to do this for more than one line. Then,

click on the link and you should connect to the corresponding page on

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CMS Announces Accreditation Exemptions

http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~National%20Supplier%20Clearinghouse~Articles~CMS%20Announces%20Accreditation%20Exemptions?opendocument

CMS Recently Announced DMEPOS Accreditation Exemptions for Medicare

Billing.

Applies to:

National Supplier Clearinghouse (NSC)//General - NSC

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that you want to receive information from us for these listserv(s):

DMERC Region C//Electronic Data Interchange (EDI)

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DMERC Region C//General - DMEPOS

DMERC Region C//Home Care Equipment Supplies

DMERC Region C//Orthotics and Prosthetics

DMERC Region C//Oxygen

DMERC Region C//Pharmacies

DMERC Region C//Power Mobility

DMERC Region C//Respiratory

General//Statistical Analysis DME (SADMERC)

General//Vendors Clearinghouses and Billing Services

General//Web Site Announcements

National Supplier Clearinghouse (NSC)//General - NSC

Jurisdiction C EDI//JCEDI

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Daily CMS NEWS

Wednesday, December 31, 2008

DME MAC A News for December 31, 2008 - KL Modifier Reminder

DME MAC A News for December 31, 2008 - DME MAC A Closed for New Year Holiday

DME MAC A News for December 31, 2008 - New KE Modifier Effective January 1, 2009

DME MAC A News for December 31, 2008 - Weekly Updates

Tuesday, December 30, 2008

DME MAC Jurisdiction C News

Monday, December 29, 2008

Jurisdiction B News: Surgical Dressings Code A6545

EDI News: Claim Status Inquiry (CSI) CBT Now Available

EDI News: Total Electronic Environment Course Now Available

Jurisdiction B News: Comment Period Instructions for Oxygen Payment Rules

CEDI Help Desk Will be Closed on New Year?s Day

Friday, December 26, 2008

DME MAC A News for December 26, 2008 - Weekly Updates

DME MAC A News for December 26, 2008 - DME MAC A Test Your Knowledge - ABN Quiz Now Available

DME MAC A News for December 26, 2008 - DME MAC Jurisdiction A Winter Webinar Schedule Reminder

Update on the CEDI Front-End Editing Process

Wednesday, December 24, 2008

DME MAC Jurisdiction C News

Newly Released MLN Matters Article of Special Interest to Medicare Suppliers

Jurisdiction B News: Electronic Reports & Top Rejections Webinar Materials

Tuesday, December 23, 2008

Palmetto GBA E-mail Update

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