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Friday, June 12, 2009

NAS DME Update



NAS DME Jurisdiction D E-mail List
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Subscribed Interests
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Mobility Devices

Join NAS For Our Wheelchair Web-based Workshop Series

If you have questions regarding the billing of manual wheelchairs, power mobility devices, or wheelchair options and accessories, attend one of the workshops NAS is offering. Each workshop will review information from the Manual Wheelchair, Power Mobility Device, and Wheelchair Options and Accessories local coverage determination (LCD) and policy article, which includes coverage and payment rules, coding guidelines, and documentation requirements.
K0823 - Notification of Prepayment Review

NAS Jurisdiction D DME MAC Medical Review will be initiating a widespread prepayment probe review of claims for HCPCS K0823; power wheelchair, group 2 standard, captain's chair capacity up to and including 300 pounds. Widespread reviews are used to determine the extent of potential problem areas across multiple suppliers. This review is being initiated based on the results of CERT (Comprehensive Error Rate Testing) analysis and analysis of adjudication claim development denials.
Manual Wheelchair Documentation Requirements

NAS has noted that some suppliers have recreated the Certificates of Medical Necessity (CMNs) or checklists with the assumption that these will support the medical necessity portion of the documentation required for manual wheelchairs. CMNs were eliminated for wheelchairs provided on/after May 5, 2005.
Group 3 Power Wheelchair Requirements

NAS would like to remind suppliers of the requirements and coverage criteria for Group 3 Power Wheelchairs, HCPCS codes K0848- K0864.
Oxygen

Oxygen Ask the Contractor Teleconference - June 30, 2009

On Tuesday, June 30, 2009, at 1:30 p.m. CT, NAS will conduct an Oxygen Ask the Contractor Teleconference (ACT). During this teleconference, knowledgeable NAS staff representing a variety of functions will be available to answer your questions regarding oxygen. If we cannot answer your question during the teleconference, we will research the issue and then call you with the answer.
General Announcements
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Join NAS For Our Many Web-based Workshops in June and July

If you have questions regarding the billing of Enteral Nutrition, Manual Wheelchair Bases, Power Mobility Devices, Wheelchair Options and Accessories, DME Modifiers, Oxygen and Oxygen Equipment, or Therapeutic Shoes for Persons with Diabetes, attend one of the workshops NAS is offering. Each workshop will review information from the Local Coverage Determination (LCD) and Policy Article, which includes coverage and payment rules, coding guidelines, and documentation requirements.
Medicare Secondary Payer

A secondary payer is an insurance plan that covers medical expenses only after a primary insurer has made payment on a claim. For example, if a claim for $100 is filed with a primary insurer under a policy with a 20% co-payment, that insurer would pay $80, while a secondary insurer may take care of the $20 co-payment.
Jurisdiction D Happenings, Issue 21, Now Available

Jurisdiction D Happenings, Issue 21, is found on our DME Web site in the News/Publications section in a PDF format. The bulletin contains educational material, claim submission reminders, reimbursement and coverage updates and much more for suppliers in Jurisdiction D. The bulletin also includes a Table of Contents that is both alphabetized and sorted by topic to allow for quick access.
July Quarterly Update for 2009 for DMEPOS MLN Matters 6511

The 2009 fees for the K0739/E1340 are provided, the addition of the AW modifier to HCPCS code A6545 (Gradient compression wrap, non-elastic, below knee, 30-50 mm hg, each) is discussed, and other updates are given.
October Quarterly Update to 2009 Annual Update of HCPCS Codes Used for SNF Consolidated Billing Enforcement MLN Matters 6503

The October quarterly update to the 2009 HCPCS codes for Skilled Nursing Facility consolidated billing are provided.
New Drug/Biological HCPCS Codes for July 2009 Update MLN Matters 6477

Updates effective for dates of service on or after July 1, 2009, (unless otherwise specified), to HCPCS codes for certain drugs and biologicals are explained. These codes include Q2023, Q4115, Q4116, J7611, J7612, J7613, and J7614.
Ask the Contractor Teleconference - June 23, 2009

On Tuesday, June 23, 2009, at 3:00 p.m. CT, NAS will conduct the DME Ask the Contractor Teleconference. During this teleconference, knowledgeable NAS staff representing a variety of functions will be available to answer your questions. If we cannot answer your question during the teleconference, we will research the issue and then call you with the answer.
Second in Series: General Equivalence Mappings - ICD-9 to and from ICD-10-CM and ICD-10-PCS Fact Sheet

CMS now offers a fact sheet with basic information about the General Equivalence Mappings.
The Medicare DMEPOS Competitive Bidding Program Round 1 Rebid is Coming Soon!

CMS provides a timeline of events for the DMEPOS Competitive Bidding Program.
Crossover Claims Impacted by Common Working File Pacific Host Site Problem - Revised

CMS revised this article to address paid claims for beneficiaries who primarily reside, or until recently resided, in Arizona, California, Hawaii, and Nevada. The previous version stated Arkansas instead of Arizona.
Other Topics
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What's New
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Supplier Contact Center Closures
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    June 19, 2009, from 8 a.m. - 12 p.m. CT for CMS-approved training (Supplier Contact Center)

Electronic Billing Questions?
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