| NHIC, Corp.DME MAC A ListServe | For Immediate Release |
| July 17, 2009 Weekly What's New The following publications have been posted to the DME MAC A What's New page: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) For more information visit: http://www.medicarenhic.com/dme/dme_whats_new.shtml Claims Processing Change for Capped Rental Modifiers (KH, KI, and KJ)Over the years, NHIC, Corp. DME MAC A has continued to correct claims with the improper use of the KH, KI, and KJ modifiers on capped rental items and PEN pumps. For claims submitted with the inappropriate capped rental "K" modifier, NHIC has manually intervened to correctly append the appropriate "K" modifier to allow for proper processing. This notice is to advise that effective with claims received on or after September 18, 2009, NHIC will no longer provide these corrections and will reject claims that are not billed with the appropriate "K" modifier with ANSI reason code 182, remark code N56.When billing a capped rental item or a PEN Pump, the "KH" modifier shall only be used for the first month of billing. The "KI" modifier shall only be used for the second and third months of billing. The "KJ" modifier shall then be used for the remainder of the capped rental period (months 4-13), and the PEN pump rental period (months 4-15). All other applicable modifiers must also be included when billing. Please reference the link below for a complete list of modifiers: http://www.medicarenhic.com/dme/medical_review/mr_hcpcs/2009_hcpcs_modifiers.pdfAdditionally, if the capped rental item was previously provided to a Medicare beneficiary and a new rental period is now being requested, a narrative must be added that clearly explains why the item is being replaced to avoid unnecessary rejections. NHIC recommends that you use our Interactive Voice Response (IVR) system at 1-866-419-9458 to verify if equipment was previously provided. Effective with claims received on or after September 18, 2009, NHIC will begin rejecting claims with modifier "KH" when a previous initial capped rental month is on file and the claim is submitted without a narrative that clearly supports a new rental period. These claims will reject with ANSI reason code 182, remark code N56.If a rejected claim occurs due to either situation outlined above (the incorrect billing of the "K" modifier or missing narrative), the claim must be corrected with the proper information and re-submitted. This correction will not be handled through the re-openings process. NHIC strongly recommends suppliers check the IVR to ensure the first month's claim (KH modifier) was appropriately adjudicated prior to billing subsequent rental months (KI and KJ modifiers). Implementation of New Provider Contact Center TechnologyTo better serve our customers, NHIC, Corp. DME MAC Jurisdiction A is implementing a new technology within the Provider Contact Center. This new technology will help reduce the time a caller spends on the phone by gathering the provider authentication elements at the beginning of the call via an automated phone system and transferring the information to the Customer Service Representative (CSR). This will allow the CSR to already have the information available when they receive the call, thus allowing them to address the caller's question more quickly. Implementation of this new technology is scheduled for July 27, 2009.The phone number for the Provider Contact Center is 866-590-6731. To utilize the Interactive Voice Response (IVR) unit, please call 866-419-9458. As a reminder, if you call the Provider Contact Center with an issue that should be addressed via the IVR, you will be referred back to the IVR line. Customer Service Representatives cannot address information that is provided via the IVR. Get Ready for DMEPOS Competitive Bidding! (CMS Message 2009-07-06)The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program Round 1 Rebid is coming soon!!Summer 2009CMS announces bidding schedule/schedule of education eventsCMS begins bidder education campaignBidder registration period to obtain user ID and passwords beginsFall 2009Bidding beginsIf you are a supplier interested in bidding, prepare now - don't wait!UPDATE YOUR NSC FILES: DMEPOS supplier standard # 2 requires ALL suppliers to notify the National Supplier Clearinghouse (NSC) of any change to the information provided on the Medicare enrollment application (CMS-855S) within 30 days of the change. DMEPOS suppliers should use the 3/09 version of the CMS-855S and should review and update:The list of products and services found in section 2.D;The Authorized Official(s) information in sections 6A and 15; andThe correspondence address in section 2A2 of the CMS-855S.This is especially important for suppliers who will be involved in the Medicare DMEPOS Competitive Bidding Program. These suppliers must ensure the information listed on their supplier files is accurate to enable participation in this program. Information and instructions on how to submit a change of information may be found on the NSC Web site (http://www.palmettogba.com/nsc) and by following this path: Supplier Enrollment/Change of Information/Change of Information Guide. GET LICENSED: Suppliers submitting a bid for a product category in a competitive bidding area (CBA) must meet all DMEPOS state licensure requirements and other applicable state licensure requirements, if any, for that product category for every state in that CBA. Prior to submitting a bid for a CBA and product category, the supplier must have a copy of the applicable state licenses on file with the NSC. As part of the bid evaluation we will verify with the NSC that the supplier has on file a copy of all applicable required state license(s). GET ACCREDITED: CMS would like to remind DMEPOS suppliers that time is running out to obtain accreditation by the September 30, 2009 deadline or risk having their Medicare Part B billing privileges revoked on October 1, 2009. Accreditation takes an average of 6 months to complete. DMEPOS suppliers should contact a CMS deemed accreditation organization to obtain information about the accreditation process and the application process. Suppliers must be accredited for a product category in order to submit a bid for that product category. CMS cannot contract with suppliers that are not accredited by a CMS-approved accreditation organization. Further information on the DMEPOS accreditation requirements along with a list of the accreditation organizations and those professionals and other persons exempted from accreditation may be found at the CMS website: http://www.cms.hhs.gov/MedicareProviderSupEnroll/01_Overview.asp GET BONDED: CMS would like to remind DMEPOS suppliers that certain suppliers will need to obtain and submit a surety bond by the October 2, 2009 deadline or risk having their Medicare Part B billing privileges revoked. Suppliers subject to the bonding requirement must be bonded in order to bid in the DMEPOS competitive bidding program. A list of sureties from which a bond can be secured is found at the Department of the Treasury's "List of Certified (Surety Bond) Companies;" the web site is located at: http://www.fms.treas.gov/c570/c570_a-z.htmlVisit the CMS website at http://www.cms.hhs.gov/DMEPOSCompetitiveBid/ for the latest information on the DMEPOS competitive bidding program. DMEPOS Supplier Accreditation and Surety Bond Requirement Deadlines Coming In October (CMS Message 2009-07-06)Suppliers May Choose to Voluntarily Terminate Enrollment If They Do Not Plan To ComplyMedicare suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), unless exempt, must be accredited and obtain a surety bond by October 1, 2009 and October 2, 2009, respectively.If you have made the decision not to obtain accreditation or a surety bond when required, you may want to voluntarily terminate your enrollment in the Medicare program before the implementation dates above. You can voluntary terminate your enrollment with the Medicare program by completing the sections associated with voluntary termination on page 4 of the Medicare enrollment application (CMS-855S). Once complete, you should sign, date and send the completed application to the National Supplier Clearinghouse (NSC). By voluntarily terminating your Medicare enrollment, you will preserve your right to re-enroll in Medicare once you meet the requirements to participate in the Medicare program.If you do not comply with the accreditation and surety bond requirements and do not submit a voluntary termination, your Medicare billing privileges will be revoked. A revocation will bar you from re-enrolling in Medicare for at least one year after the date of revocation.Suppliers who do not plan to stay enrolled in Medicare are strongly encouraged to notify their beneficiaries as soon as possible so the beneficiary can find another supplier.For additional information regarding DMEPOS accreditation or the provisions associated with a surety bond, go to http://www.cms.hhs.gov/MedicareProviderSupEnroll. Frequently Asked Questions (FAQs) on the surety bond requirement can be found on the NSC's FAQ page at http://www.palmettogba.com/nsc. DMEPOS Supplier Accreditation - Time is Running Out - Deadline is September 30, 2009Time is running out for suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) who bill Medicare under Part B to obtain accreditation by the September 30, 2009 deadline or risk having their Medicare Part B billing privileges revoked on October 1, 2009. A new MLN Matters Special Edition article on this subject is now available. This article outlines what you need to do if you have not yet complied with the Medicare Program's supplier and quality standards to become accredited. To view the article on the CMS website, go to: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0903.pdfWhile the accreditation process takes on average 6-7 months to complete, the process could take as long as 9 months to complete. Accordingly, DMEPOS suppliers should contact an accreditation organization right away to obtain information about the accreditation process and submit an application.In order to retain or obtain a Medicare Part B billing number, all DMEPOS suppliers (except for exempted professionals and other persons as specified by the Secretary) must comply with the Medicare program's supplier standards and quality standards to become accredited. The accreditation requirement applies to suppliers of durable medical equipment, medical supplies, home dialysis supplies and equipment, therapeutic shoes, parenteral/enteral nutrition, transfusion medicine and prosthetic devices, and prosthetics and orthotics.Pharmacies, pedorthists, mastectomy fitters, orthopedic fitters/technicians and athletic trainers must also meet the September 30, 2009 deadline for DMEPOS accreditation. Certain eligible professionals and other persons as specified by the Secretary are exempt from the accreditation requirement.Further information on the DMEPOS accreditation requirements along with a list of the accreditation organizations and those professionals and other persons exempted from accreditation may be found at the CMS website: http://www.cms.hhs.gov/MedicareProviderSupEnroll/DMEPOS_DeemedAccreditationOrganizations.asp#TopOfPage |
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