Daily CMS NEWS: October 2009

Friday, October 30, 2009

DME MAC Jurisdiction C News

Reasonable Charge Update for 2010 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, and Certain Intraocular Lenses
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6691.pdf

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Medicare DMEPOS Rules to Take Effect in 2010

The Centers for Medicare & Medicaid Services (CMS) has announced that the following final rule is on display at the Federal Register:

Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010

The rule can be viewed at: http://federalregister.gov/page2.aspx

This final rule includes rules regarding the following Durable Medical Equipment Prosthetics/Orthotics and Supplies (DMEPOS) subjects:

(1) maintenance and servicing of oxygen equipment;

(2) the establishment of a notification process for suppliers choosing to become grandfathered suppliers under the DMEPOS Competitive Bidding Program; and

(3) payment for damages resulting from termination of contracts awarded in 2008 under Round 1 of the DMEPOS Competitive Bidding Program

Maintenance and Servicing of Oxygen Equipment

New rules regarding payment and supplier responsibilities for maintenance and servicing of oxygen equipment have been established in accordance with Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 requirements. The new maintenance and servicing rules permit payment every 6 months, beginning 6 months after the end of the 36 month rental payment cap, for maintenance and servicing of oxygen concentrators and transfilling equipment to ensure that the equipment is kept in good working order for the safety of the beneficiary. The new rules are effective for items furnished on or after July 1, 1010. The maintenance and servicing policy established for 2009 as part of an Interim Final Rule (73 FR 69726) will continue for items furnished through June 30, 2010.

Beginning July 1, 2010, a single maintenance and servicing payment of $66 may be made once every 6 months for maintenance and servicing of an oxygen concentrator (stationary or portable) and, if applicable, oxygen transfilling equipment. Separate payment is not made for each piece of equipment serviced. The maintenance and servicing payment does not apply to liquid or gaseous oxygen equipment (stationary or portable). The maintenance and servicing fee covers all maintenance and servicing needed during the 6 month period. The supplier is responsible for performing all necessary maintenance, servicing and repair of the equipment at the time it is needed and must also visit the beneficiary's home during the first month of each 6 month period to inspect the equipment and perform any necessary maintenance and servicing needed at the time of each visit.

CMS will issue program guidance with specific information for claims processing and beneficiary education over the next few months.

Grandfathering Notification Process

A process has been established for suppliers that are not awarded contracts under the DMEPOS Competitive Bidding Program to provide notification of their decisions regarding whether they will continue furnishing rented durable medical equipment (DME) and/or oxygen and oxygen equipment as grandfathered suppliers under the program. This process requires noncontract suppliers to provide written notification of their grandfathering decisions to CMS and all Medicare beneficiaries who reside in a competitive bidding area to whom they are furnishing these items. The process also requires beneficiaries to notify grandfathered suppliers regarding whether they wish to continue receiving their items from a grandfathered supplier.

The regulation also establishes a requirement that there be coordination between contract and noncontract suppliers regarding the removal and delivery of medically necessary items to and from a beneficiary's home. Noncontract and contract suppliers are required to work together to ensure that DMEPOS services are uninterrupted.

A grandfathered item is defined in the regulation to encompass all oxygen and oxygen equipment or all rented DME within a product category other than oxygen and oxygen equipment. Therefore, if a supplier chooses to become a grandfathered supplier for oxygen and oxygen equipment, it must continue to furnish all items of oxygen and oxygen equipment to all beneficiaries who choose to continue receiving the items from the grandfathered supplier. Likewise, if a supplier chooses to become a grandfathered supplier for an item of rented DME in a given product category, it must continue to furnish all rented DME in the product category to all beneficiaries who choose to continue receiving the items from the grandfathered supplier.

Process for Considering Claims for DAMAGES

MIPPA terminated contracts awarded under Round 1 of the Medicare DMEPOS Competitive Bidding Program and stipulated that, to the extent that any damages may be applicable as a result of the termination of contracts, such damages shall be payable from the Federal Supplementary Medical Insurance Trust Fund.

In accordance with the final regulation, claims for damages may only be filed by suppliers that submitted a bid and were awarded a contract in 2008 during Round 1 of the program. Any damages that are claimed must be substantiated and must be the direct result of termination of a contract under Round 1 of the program. The extent of the obligation for payment of damages is limited to damages realized by the contract supplier. Therefore, entities that entered into subcontracting relationships with a contract supplier for purposes related to the furnishing items and services under the program are not eligible to submit claims for damages.

The Competitive Bidding Implementation Contractor (CBIC) will be the intake point for claims for damages, which will be reviewed by the CBIC and CMS. Claims must comply with all requirements specified in the final regulations. The CBIC will accept claims that are submitted by April 1, 2010. The date of submission is the actual date of receipt of the completed claim by the CBIC. No claims for damages will be accepted if they are received by the CBIC after April 1, 2010. If a claim for damages is not submitted by the deadline, the CBIC will recommend to CMS not to process the claim any further.

Claims for damages must be submitted in writing to the following address (electronic submissions via e-mail or facsimile will not be accepted):

Competitive Bidding Implementation Contractor

2743 Perimeter Pkwy, Ste 200-400

Augusta, Georgia 30909-6499

Every effort will be made to make a determination within 120 days of initial receipt of a claim or the receipt of additional information, whichever is later. However, in the case of more complex cases, or in the event that a large volume of claims is submitted, it may take more than 120 days to process a claim.

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Message for Providers/Suppliers Concerning CR 6421-- Editing the Ordering/Referring Provider in DMEPOS Claims

Message for Providers/Suppliers

Concerning CR 6421

TO: DMEPOS suppliers and their billing agents/clearinghouses

Physicians/non-physician practitioners and their group practice offices

SUBJECT: Change Request 6421â€”Editing the Ordering/Referring Provider in DMEPOS Claims

This message is directed at Medicare suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), their billing agents and clearinghouses, and the physicians and non-physician practitioners who order items of DMEPOS for their Medicare patients. We refer to those physicians and non-physician practitioners as "ordering/referring providers."

Background:

To implement Section 1833(q) of the Social Security Act that requires all physicians and non-physician practitioners that meet the definitions at section 1861(r) and 1842(b)(18)(C) be uniquely identified for all claims for services that are ordered or referred and to address concerns raised by Congress, the public, and Government agencies for paying claims for DMEPOS that were ordered by physicians or non-physician practitioners who were not permitted by the Medicare program to do so.

As a first step in addressing these concerns, the Centers for Medicare & Medicaid Services (CMS) is verifying that the ordering/referring provider on a DMEPOS claim (1) has a current enrollment record in Medicare (i.e., the ordering/referring provider enrolled or updated his/her enrollment record within the past 5 years and the NPI is in the record) and (2) is of a specialty that is eligible to order and refer.

This verification is being implemented in two phases:

· In Phase 1 (October 5, 2009 through January 3, 2010), DMEPOS suppliers who report ordering/referring providers who do not pass both edits will receive an informational message on their remittance. (Paper billers will not receive an informational message.) The claims will be paid.

· In Phase 2 (January 4, 2010 and thereafter), DMEPOS suppliers who report ordering/referring providers who do not pass both edits will have their claims rejected.

The following physicians and non-physician practitioners may order/refer in the Medicare program:

Physicians (doctors of medicine or osteopathy—all specialties, and doctors of dental medicine, dental surgery, podiatric medicine, optometry, and chiropractic medicine)

Physician assistants,

Certified Clinical Nurse Specialists,

Nurse Practitioners,

Clinical Psychologists,

Certified Nurse Midwives, and

Clinical Social Workers.

How the new edits are being implemented:

CMS has furnished the DME claims processing system with a national file that was generated from the CMS' national provider enrollment repository, Provider Enrollment, Chain and Ownership System (PECOS). We refer to this file as the PECOS List. PECOS maintains Medicare enrollment information for all providers and suppliers (including physicians and the non-physician practitioners shown above), except DMEPOS suppliers; however, it is important to note that PECOS only maintains enrollment information for physicians and non-physician practitioners if they have enrolled or updated their enrollment information since November 2003.

Medicare transmits updates to the PECOS List daily to the claims processing system. The PECOS List contains only the physicians and non-physician practitioners who are enrolled in the above specialties and who have current enrollment records (i.e., they have enrollment records in PECOS that contain their NPIs). CEDI (the front-end claims processing system for electronic DMEPOS claims) compares the NPI and the first letter of the first name and the first four letters of the last name of the ordering/referring provider as reported on the claim to that same information in the PECOS List. If a match is found, no informational message is sent to the DMEPOS supplier in the Remittance. If a match is not found, an informational message is sent to the DMEPOS supplier in the Remittance. Beginning January 5, 2010 and thereafter, if a match is not found, the claim will be rejected.

CMS actions to mitigate the number of information messages:

Since many DMEPOS suppliers are receiving informational messages in their Remittances, CMS is taking the following actions to reduce the number of informational messages:

1. Prior to the implementation of Phase 2, CMS will systematically add the NPIs to the PECOS enrollment records of all physicians and non-physician practitioners whose PECOS records do not contain their NPIs. Because the NPI is one of the matching criteria used in implementing the edits, it is essential that the NPI be in the PECOS enrollment record. Because the PECOS List contains only physicians and non-physician practitioners who are in PECOS with NPIs in their enrollment records, this action will result in the addition of many more physicians and non-physician practitioners to the PECOS List.

2. Prior to the implementation of Phase 2, CMS will make publicly available on the Internet a national file of Medicare physicians and non-physician practitioners who are eligible to order/refer. The file will contain the NPI and the Legal Name (from the Medicare PECOS enrollment record). This will allow DMEPOS suppliers to determine if the ordering/referring provider has a current Medicare enrollment record and is eligible to order or refer.

3. Prior to the implementation of Phase 2, CMS will issue instructions that will assist Medicare contractors in enrolling licensed residents, Department of Veterans Affairs physicians, and Public Health Service physicians. These physicians continue to order DMEPOS but have not enrolled in Medicare because they are not eligible for payments from Medicare. The instructions will also state that the teaching physician should be reported as the ordering/referring physician in situations where a resident orders DMEPOS but is not licensed by the State and thus cannot enroll in Medicare. Note that dentists and pediatricians, who may sometimes order DMEPOS for Medicare beneficiaries but who have not enrolled in Medicare because they see so few Medicare patients or most of their services are not covered by Medicare, are considered "physicians" in terms of eligibility to order/refer, have been and continue to be eligible to enroll in the Medicare program.

4. An MLN Matters Article (MM6421) about CR 6421 is available on the CMS web site. To supplement that Article, CMS will be preparing a Special Edition Medicare Learning Network (MLN) Matters Article about CR 6421.

5. CMS's Medicare contractors have also initiated a revalidation effort (via CR 6574, Transmittal 557) which is designed to update the Medicare enrollment record for 2,500 physicians and non-physician practitioners (50 practitioners per State). We expect that this revalidation effort will be complete or nearing completion by the time that Phase 2 is implemented.

Points to remember:

· For DMEPOS suppliers—

o Upon implementation of Phase 2, only accept and fill orders from eligible Medicare providers. The CMS national file mentioned in item 2 above will greatly assist you.

o If you submit electronic claims, ensure that the ordering/referring provider name is reported in all uppercase letters. This information is included in the CEDI Companion Document and some of the DME MACs have made this information available separately from the Companion Document.

o Do not report a nickname in the ordering/referring provider name. For example, a reported first name of "BOB" will result in a non-match to the first name of "ROBERT" (editing includes the comparison of the first initial of the first name), causing the claim to fail the two new edits.

o Do not use commas, periods, or apostrophes within the ordering/referring provider's name. For example, "O'CONNELL" should be reported as "OCONNELL".

o Ensure that names are reported correctly. For example, do not include credentials in a name field in the name segment for the ordering/referring provider (e.g., do not report a first name as "DR JOHN.")

o Use of the Advance Beneficiary Notice of Noncoverage (ABN) is not appropriate on a rejected claim. An ABN is appropriate only when a provider/supplier expects Medicare to deny coverage for an item or service under the Limitation on Liability provisions of Section 1879 of the Social Security Act.

o Many ordering/referring providers are getting their enrollment information into PECOS or are updating their enrollment information. It may take some time for a Medicare enrollment contractor to process these enrollment applications. Once an application has been approved, the ordering/referring provider will have an enrollment record in PECOS that contains the NPI. After the implementation of Phase 2, a DMEPOS claim may identify an ordering/referring provider who now has a current enrollment record (i.e., in PECOS with the NPI in the record) but the date of service that precedes the date the ordering/referring provider's information was effective in PECOS. Such a claim would pass the two new editsâ€”Medicare is not comparing the date of service on the claim to the date the ordering/referring provider was effective in PECOS. The claim would not be rejected.

· For ordering/referring providers—

o If you are not enrolled in the Medicare program, or if you enrolled more than 5 years ago and have not submitted any updates or changes to your enrollment information in 5 years, you do not have an enrollment record in PECOS. In order to continue to order DMEPOS for Medicare beneficiaries, you will have to enroll in the Medicare program or "revalidate" your Medicare enrollment information. You may do so by (1) using Internet-based PECOS (which transmits your enrollment application to the Medicare carrier or A/B MAC via the Internetâ€”be sure to mail the signed and dated Certification Statement to the carrier or A/B MAC immediately after submitting the appllication), or (2) by filling out the appropriate paper Medicare provider enrollment application(s) and mailing it, along with any required additional paper information, to the local Medicare carrier or A/B MAC, who will enter your information into PECOS and process your enrollment application. Information about enrolling in Medicare is found on the CMS web site at www.cms.hhs.gov/MedicareProviderSupEnroll.

o Make sure you have a current enrollment record in Medicare. You can do this by calling your designated enrollment contractor or you can go on-line, using Internet-based PECOS, to view your enrollment record. While doing so, if you have a PECOS record, ensure that your NPI is in it. If it is not, update your enrollment record. You can find information about Internet-based PECOS and a link to Internet-based PECOS at www.cms.hhs.gov/MedicareProviderSupEnroll. We recommend that all providers and suppliers read the information and downloadable documents about Internet-based PECOS that are available on the CMS provider/supplier enrollment web page: www.cms.hhs.gov/MedicareProviderSupEnroll.

o If you are a dentist or other specialty who is eligible to order/refer but have not enrolled in Medicare because the services you provide are not covered by Medicare, you need to enroll in Medicare order to continue to order or refer in the Medicare program.

o If you are a physician who is employed by the Department of Veterans Affairs or the Public Health Service but have not enrolled in Medicare because you would not be paid by Medicare for your services, you need to enroll in Medicare in order to continue to order or refer in the Medicare program.

o If you are a resident who has a medical license but have not enrolled in Medicare because you would not be paid by Medicare for your services, you need to enroll in Medicare in order to continue to order or refer in the Medicare program. Residents who do not have medical licenses are not eligible to enroll in the Medicare program. Should they order or refer, the teaching physician is to be reported in a claim as the ordering/referring provider.

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Flu Season is upon us! CMS encourages providers to begin taking advantage of each office visit to encourage your patients with Medicare to get seasonal flu shots. Flu shots are their best defense against combating flu this season. And don't forgetâ€”health care workers also need to protect themselves.

Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient as a part B benefit. No deductible or copayment/coinsurance applies. Note that influenza vaccine is NOT a Part D covered Drug.

For more information about Medicare's coverage of the seasonal influenza vaccine and its administration, as well as related educational resources for health care professionals, please go to http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp on the CMS website.

For information on Medicare policies related to H1N1 influenza, please go to http://www.cms.hhs.gov/H1N1 on the CMS website.

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Jurisdiction B News: New Computer Based Training (CBT) Course Now Available

New Computer Based Training (CBT) Course Now Available The Jurisdiction B DME MAC strives to deliver detailed information through several resources including the Medicare University. Now available on Medicare University is a new computer based training course. This computer based training course is an interactive online tutorial, which has been developed to help assist in the dissemination of supplier information. The Modifiers Computer Based Training Course is now available. This course will cover the most commonly submitted modifiers and provide billing instructions and resources for DMEPOS suppliers. To access Medicare University click on or paste the following link into your Internet browser: http://www.medicareuniversity.com/index.jsp Once in Medicare University:Login or Create a New UserGo to the Course Catalog and locate Catalog ID DME-C-0019Click on the Details buttonClick on the Enroll buttonClick on the Curriculum List tab and select the Go button next to Catalog ID DME-C-0019Click on Launch

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NAS DME Update

NAS DME Jurisdiction D E-mail List

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CMS Special Open Door Forum: Medicare DMEPOS Competitive Bidding Program Bidders' Conference: Open Call

Wednesday, November 4, 2009

2 - 3 p.m. Eastern Time

Conference Call Only

Please join us for the eighth and final Special Open Door Forum (ODF) bidders' conference for the Round 1 Rebid of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program. At this Special ODF, we will respond to prospective bidders' questions about the competitive bidding process. If you have questions you would like to submit in advance of the ODF, please e-mail them to CMS at cbic.teleconference@PalmettoGBA.com by November 1, 2009.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkVylEAuppZnMYRwml&tmpl=dme_viewnews&style=part_ab_viewnews

RiverTrust Solutions, Inc. Address Change

In an effort to streamline the mail receipts, effective immediately RiverTrust Solutions, Inc. has a new mailing address for regular mail as well as overnight and priority deliveries.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkVylEAVpuiAeJimey&tmpl=dme_viewnews&style=part_ab_viewnews

Why Was My Written Inquiry, Redetermination or Reopening Request Dismissed?

This article explains why claims previously denied as unprocessable are being dismissed and result in front-end dismissal letters.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkVylEAyZuxQcrFyWe&tmpl=dme_viewnews&style=part_ab_viewnews

Only 5 Days Left to Register for Round 1 Rebid of DMEPOS Competitive Bidding Program

If you are a supplier interested in participating in the Round 1 Rebid of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program, you must register before November 4, 2009 at 9 p.m. EST. Suppliers that do not register cannot bid and are not eligible for contracts. Don't wait - go to http://www.dmecompetitivebid.com and register TODAY!

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkVylEAlkkymOqZXnC&tmpl=dme_viewnews&style=part_ab_viewnews

Thursday, October 29, 2009

DME MAC Jurisdiction C News

NCPDP Front-End Transition Reminder - As a reminder, the current NCPDP front-end process will be transitioning from the DME MACs to CEDI beginning November 2009 and completing in December 2009.http://www.cignagovernmentservices.com/jc/pubs/news/2009/1009/cope10917.html"> Read more...
http://www.cignagovernmentservices.com/jc/pubs/news/2009/1009/cope10917.html

Reopening Requests for Modifiers KX, GA, GZ, and GY - Reopening requests to add, change, or remove modifiers KX, GA, GZ, and GY will no longer be accepted for dates of receipt on or after December 1, 2009.http://www.cignagovernmentservices.com/jc/pubs/news/2009/1009/cope10923.html"> Read more...
http://www.cignagovernmentservices.com/jc/pubs/news/2009/1009/cope10923.html

Oxygen Modality Changes after the 36-Month Capped Rental Period - According to the Oxygen and Oxygen Equipment Policy Article (A33750), oxygen patients may change modalities in certain circumstances. Changing modalities may occur during the initial 36-month rental period or after the rental period has ended (i.e., when billing for contents).http://www.cignagovernmentservices.com/jc/pubs/news/2009/1009/cope10919.html"> Read more...
http://www.cignagovernmentservices.com/jc/pubs/news/2009/1009/cope10919.html

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Make Plans Now to Attend the Medicare University 2009 Virtual Convention

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Make Plans Now to Attend the Medicare University 2009 Virtual ConventionAre you tired of airport security lines, flight delays, airport food, and the middle seat?
We are too!
You can afford to miss the airport hassles, but you can't afford to miss the educational opportunities offered at the Medicare University 2009 Virtual Convention.
From November 16-20, National Government Services staff and other Medicare-affiliated organizations will present 60 educational courses. Enjoy education at your convenience from your personal computer or laptop.Don't have enough time to slip away to class? No need to worry. On-demand replays will be offered to all paid attendees for at least 30 days after the convention concludes.So sit back, relax, and join us at the first-ever Medicare University 2009 Virtual Convention.
Earn Up to 57 Continuing Education UnitsNational Government Services is pleased to announce that the American Academy of Professional Coders (AAPC) has granted all courses offered during the Medicare University 2009 Virtual Convention eligible for one continuing education unit (CEU). Those registered for the convention may earn up to 21 CEUs by attending one course each hour of each day during the conference week.In addition, an on-demand feature allows paid attendees to access missed courses up to 30 days after the convention closes. CEUs also may be earned for on-demand sessions, with a possibility of obtaining a total of 57 CEUs!

This program/publication/ subscription/etc. has prior approval of the American Academy of Professional Coders for continuing education units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content or the program sponsor.

• 60 sessions

• $150 per attendee

• No travel costs

• Earn up to 57 CEUs

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Wednesday, October 28, 2009

Palmetto GBA E-mail Update

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Please do not reply to this message. This is an announcement e-mail only.

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Only One Week Left to Register for the Round One Rebid of the DMEPOS

Competitive Bidding Program

Reminder: If you are a supplier interested in participating in the Round 1

Rebid of the Medicare durable medical equipment, prosthetics, orthotics,

and supplies (DMEPOS) competitive bidding program, you must register before

November 4, 2009, at 9 pm ET. Suppliers that do not register cannot bid and

are not eligible for contracts.

http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9NYK1260?opendocument

Applies to:

National Supplier Clearinghouse (NSC)//General - NSC

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DMERC Region C//Oxygen

DMERC Region C//Pharmacies

DMERC Region C//Power Mobility

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Jurisdiction B News: November 12th - Open Question & Answer ACT

November 12, Open Question & Answer Ask-the-Contractor Teleconference National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) will conduct an Open Question and Answer Ask-the-Contractor Teleconference for Medicare fee-for-service DMEPOS suppliers. This call will take place on Thursday, November 12, 2009 at 2:00 pm eastern standard time. This teleconference will be an open question and answer session with representation from all the Jurisdiction B DME MAC departments.This teleconference is recommended for all Durable Medical Equipment (DME) suppliers who bill the Jurisdiction B DME MAC. We encourage all Medicare fee-for-service DMEPOS suppliers to sign up for this free educational opportunity. This teleconference will be approximately 90 minutes. Participants will earn 1 Medicare University credit for attending this session. Additional information will be provided during the teleconference for instructions on how to obtain credit. Registration is available online only! To register online, please click on the following link:http://www.ngsmedicare.com/ADC/EventList.aspx?fromdate=11/1/2009&todate=11/30/2009&display=Month&type=public&eventidn=806&view=EventDetails&information_id=1069
Registration InstructionsOnce you are on the "Events Calendar" page, click the link for the event for which you wish to register and follow these instructions:On the "Events Details page", click the icon above the dark blue line on the page that says "Register". A new screen will pop up entitled, "Event Registration Form", please fill out all required information and click <Next>.The "Event Registration Form-Confirmation" screen will appear.Verify your entries and click <Next> at the bottom of the registration screen.A new screen will appear, "Event Registration - Thank you!" to very successful registration.An email confirmation will immediately be sent to the email address you provided.Review and print the email confirmation - Do not delete the confirmation as it contains the dial in instructions. It is important that you save this e-mail confirmation in order to attend the November 12th ACT.

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DME MAC Jurisdiction C News

Only 1 Week Left to Register for the Round 1 Rebid of the DMEPOS Competitive Bidding Program - If you are a supplier interested in participating in the Round 1 Rebid of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program, you must register before November 4, 2009 at 9:00 p.m. EST. Suppliers that do not register cannot bid and are not eligible for contracts. Read more...
http://www.cignagovernmentservices.com/jc/pubs/news/2009/1009/cope10921.html

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Jurisdiction B News: Only 1 Week Left to Register for the Round 1 Rebid

Only 1 Week Left to Register for the Round 1 Rebid of the DMEPOS Competitive Bidding Program (CMS Message 200910-40) Reminder: If you are a supplier interested in participating in the Round 1 Rebid of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program, you must register before November 4, 2009 at 9:00 p.m. EST. Suppliers that do not register cannot bid and are not eligible for contracts. Don t wait – go to www.dmecompetitivebid.com and register TODAY!

The target registration dates for Authorized Officials (AOs) and Backup Authorized Officials (BAOs) to register in CMS Individuals Authorized Access to the CMS Computer Services (IACS) system have passed. End Users (EUs), as well as any AOs and BAOs who have not yet registered, should be registering now. Only suppliers that have registered and received a user ID and password will be able to access the on-line bidding system and submit bids. If the AO for your company has not already registered, we cannot guarantee that he or she will be able to complete the registration process before registration closes. This is especially a concern if the National Supplier Clearinghouse (NSC) record for your company is not current and accurate. If your AO does not register, you cannot bid and will not be eligible for a contract. In addition, suppliers whose AOs have not registered are at risk of experiencing delays in accessing the on-line bidding system to get a bidder number and thereby missing the opportunity to submit financial documents by the Covered Document Review Date (CDRD).
If you have registered an AO but not a BAO, we strongly recommend that a BAO register now. The establishment of a BAO is encouraged, if your company has someone who can occupy the BAO role, to avoid any disruption in the bidding process. The individual in the BAO role can assume the AO role if for some reason the AO can no longer fulfill his or her bidding responsibilities. If there is no BAO for a company and the AO leaves the company, all end users associated with the company will lose access to the bidding system. Remember, the AO and BAO must be listed on the CMS-855S enrollment form as an AO. Once the AO registers, then the AO s user ID and password will be sent by mail and should be delivered within 10 days after successful registration. After an AO receives his or her user ID and password, the AO may designate other employees to serve as BAOs and/or EUs. BAOs and EUs must also register in order to be able to use the on-line bidding system. The legal name, date of birth, and Social Security number (SSN) of the AO and BAOs must match exactly with what is on file with the NSC in order to register successfully. Legal names, dates of birth, and SSNs of all users must also match what is on file with the Social Security Administration. No AOs, BAOs, or EUs can register after registration closes on November 4, 2009 at 9:00 p.m. EST. To register, go to the Competitive Bidding Implementation Contractor (CBIC) website at www.dmecompetitivebid.com. Please review the IACS Reference Guide for step-by-step instructions on registration. The CBIC web site also has the following useful registration tools: a checklist; Quick Step guides; and frequently asked questions. If you have any questions about the registration process, please contact the CBIC Customer Service Center at 1-877-577-5331.
Please note: If you have trouble with any links below, please cut and paste the url into your browser.

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Jurisdiction B News: Claim Submission Errors & Telephone and Written Inquiries

National Government Services has analyzed data of the top claim submission errors (CSEs), telephone inquiries, and written inquiries received from our suppliers during the month of September 2009. The reports developed provide details about the claim submission errors and inquiries as well as information and resources to assist the supplier community in avoiding and resolving the issues. These reports for September 2009 have now been posted to the National Government Services Web site.

September 2009 Claim Submission Errors: http://www.ngsmedicare.com/content.aspx?CatID=3&DOCID=189
September 2009 Telephone and Written Inquiries:
http://www.ngsmedicare.com/content.aspx?CatID=3&DOCID=217

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Jurisdiction B News: Medicare Advantage Annual Election Period

Reminder: Medicare Advantage Annual Election Period and Open Enrollment Period Begins November 15, 2009 and Continues through March 31, 2010 Medicare Advantage Plans are health plan options that are approved by Medicare, but are ran by private insurance companies. They are part of the Medicare Program, and sometimes called Part C . When a Medicare eligible beneficiary elects to join a Medicare Advantage Plan, the Medicare beneficiary still receives Medicare coverage; however in most cases the Medicare beneficiary must receive services from network physicians and suppliers. November 15, 2009 marks the beginning of the Medicare Advantage Annual Election Period (AEP) for Medicare beneficiaries. During the annual election period, Medicare beneficiaries may enroll in or disenroll from a Medicare Advantage Plan. The annual election period is also referred to as the Fall Open Enrollment Season in Medicare beneficiary publications and other resource tools. The annual election period occurs November 15 throughDecember 31 of every year. In addition to the opportunities available during the Annual Election Period, Medicare eligible beneficiaries may make one Medicare Advantage Open Enrollment Period (OEP) enrollment request from January 1st through March31stof every year. Note: Please refer to the CMS Internet Only Manual, Publication 100-16 Medicare Manage Care Manual for specific CMS instruction regarding the Medicare Managed Care Plans. To avoid OA-24 denials due to a Medicare Advantage Plan enrollment, suppliers are encouraged to pre-screen their new patients for Medicare Advantage Plans and re-confirm medical coverage for existing patients. The Jurisdiction B DME MAC Interactive Voice Response (IVR) system may be accessed to verify the beneficiary s eligibility. By selection option 2 (eligibility) from the main menu, suppliers can verify the Medicare Advantage Plan number, address, telephone number and effective/termination dates. The IVR can be accessed at 1-877-299-7900 Monday through Friday, from 7:00 a.m. until 6:00 p.m. Eastern Time and Saturdays from 7:00 a.m. until 3:00 p.m. Eastern Time. The Jurisdiction B DME MAC Claim Status Inquiry (CSI) is also available to assist suppliers in confirming Medicare Advantage Plans. CSI is available from 7:00 a.m. until 6:00 p.m. Eastern Time, Monday through Friday and 7:00 a.m. until 3:00 p.m. Eastern Time on Saturdays. Suppliers may obtain CSI enrollment information on the National Government Services Web site at: http://www.ngsmedicare.com/content.aspx?CatID=3&DOCID=161
For additional details on how to prevent ANSI OA-24 and OA-109 denials, please view the article titled How to Prevent OA-109 Claim Denials on the National Government Services Web site at: http://www.ngsmedicare.com/pdf/oa-109_092508.pdf

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Tuesday, October 27, 2009

DME MAC Jurisdiction C News

Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Bidders' Conference: Open Call: Please join us for the eighth and final Special Open Door Forum (ODF) bidders' conference for the Round 1 Rebid of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program. At this Special ODF, we will respond to prospective bidders' questions about the competitive bidding process. Read more...
http://www.cignagovernmentservices.com/jc/pubs/news/2009/1009/cope10900.html

REVISED: Implementation of Health Insurance Portability and Accountability Act of 1996 (HIPAA) version 5010 for Transaction 835 - Health Care Claim Payment/Advice
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6589.pdf

Upcoming DME Provider Contact Center Closures: The DME Jurisdiction C Provider Contact Center will be closed for staff training and in observance of the Veterans Day holiday on Wednesday, November 11, 2009 from 8:00 a.m. to 1:00 p.m. Central Time. The Contact Center will also be closed on Wednesday, November 18, 2009 from 1:45 p.m. to 3:45 p.m. Central Time for administrative purposes. Read more...
http://www.cignagovernmentservices.com/jc/pubs/news/2009/1009/cope10902.html

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New Medicare Requirements Take Effect for Suppliers of Medical Equipment and Supplies

New Standards Prevent Fraud and Promote Quality Care

CMS issued a final reminder about new requirements for most suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) to meet new quality standards by October 1 and obtain a surety bond by October 2 as required under Federal law. These new supplier enrollment requirements will help to prevent fraud in Medicare and ensure that people with Medicare get high-quality medical items and services from qualified suppliers.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkVyVZkyEkJtSkhKdb&tmpl=dme_viewnews&style=part_ab_viewnews

Revised October 2009 ASP File Now Available

CMS has posted the revised October 2009 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files, which are available for download at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a1_2009aspfiles.asp.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkVyVZkZpysQPKZTkR&tmpl=dme_viewnews&style=part_ab_viewnews

New Form for DME RAC Overpayment Redeterminations

In order to improve our customer service for suppliers requesting a review of a Recovery Audit Contractor (RAC) overpayment, NAS has created a new DME RAC Overpayment Redetermination Form. NAS encourages suppliers to complete the new form and mail it to the address below with a copy of the overpayment letter.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkVyVZkZVZwrOQUbwg&tmpl=dme_viewnews&style=part_ab_viewnews

Glucose Monitor and Testing Supplies Workshop

Attention suppliers of glucose monitors and testing supplies! Join us for a 60-minute presentation on the Glucose Monitor Local Coverage Determination and Policy Article. This workshop will outline coverage and payment rules and emphasize documentation requirements. You will also receive instruction on the spanning of dates requirement as well as the appropriate modifiers to use when billing claims.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkVyVZklpltXAJVwzC&tmpl=dme_viewnews&style=part_ab_viewnews

Advance Beneficiary Notice of Noncoverage Workshop

Do you have questions about when to use an Advance Beneficiary Notice of Noncoverage (ABN)? Join us for a 75-minute workshop as we discuss the proper use of an ABN and give step-by-step instructions on completing the ABN.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkVyVZklAAITqlWXRS&tmpl=dme_viewnews&style=part_ab_viewnews

Daily CMS NEWS

Friday, October 30, 2009

DME MAC Jurisdiction C News

Medicare DMEPOS Rules to Take Effect in 2010

Message for Providers/Suppliers Concerning CR 6421-- Editing the Ordering/Referring Provider in DMEPOS Claims

Jurisdiction B News: New Computer Based Training (CBT) Course Now Available

NAS DME Update

Thursday, October 29, 2009

DME MAC Jurisdiction C News

Make Plans Now to Attend the Medicare University 2009 Virtual Convention

Wednesday, October 28, 2009

Palmetto GBA E-mail Update

Jurisdiction B News: November 12th - Open Question & Answer ACT

DME MAC Jurisdiction C News

Jurisdiction B News: Only 1 Week Left to Register for the Round 1 Rebid

Jurisdiction B News: Claim Submission Errors & Telephone and Written Inquiries

Jurisdiction B News: Medicare Advantage Annual Election Period

Tuesday, October 27, 2009

DME MAC Jurisdiction C News

NAS DME Update

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