Jurisdiction B News: Administrative Simplification Compliance Act CBT Available

 

National Government Services, the Jurisdiction B DME MAC strives to deliver detailed education and information through several resources including Medicare University.  Medicare University is an educational program designed to provide a broad variety of Medicare.  Now available through Medicare University is the Administrative Simplification Compliance Act (ASCA) Computer Based Training (CBT) course. The Administrative Simplification Compliance Act (ASCA) CBT will provide details on the ASCA provision, the limited exceptions and what to do when an ASCA request for documentation letter is received.  This CBT is for all suppliers that bill paper claims to National Government Services, the Jurisdiction B DME MAC.  To access Medicare University for this new CBT, click on or paste the following link into your Internet browser:  http://www.ngsmedicare.com/NGSMedicare/DMEMAC/Educationand Support/MedicareUniversity/MedUniv.aspx

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.  To unsubscribe/change profile: click here.

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Jurisdiction B News: LCD and Policy Article Revisions - June 25, 2009

 

LCD and Policy Article Revisions - June 25, 2009 Outlined below are the principal changes to several DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted.  Please review the entire LCD and each related Policy Article for complete information. Automatic External Defibrillators  LCDRevision Effective Date: 09/01/2009 HCPCS MODIFIERS:Added: GA and GZ modifiers Revised: KX ModifierDOCUMENTATION REQUIREMENTS:Added: Instructions for use of GA and GZ modifiers Policy ArticleRevision Effective Date: 09/01/2009 CODING GUIDELINES: Changed: SADMERC to PDAC Canes and Crutches Policy ArticleRevision Effective Date: 07/01/2009 CODING GUIDELINES: Changed: SADMERC to PDAC Cervical Traction Devices  LCDRevision Effective Date: 09/01/2009INDICATIONS AND LIMITATIONS OF COVERAGE:Removed: E0856 from range of covered codesHCPCS CODES AND MODIFIERS:Added: GA and GZ modifiersRevised: KX modifierDOCUMENTATION REQUIREMENTS:Added: Instructions for the use of GA and GZ modifiers Policy ArticleRevision Effective Date: 09/01/2009CODING GUIDELINES:Changed: SADMERC to PDAC Cold Therapy Policy ArticleRevision Effective Date: 07/01/2009CODING GUIDELINES:Changed: SADMERC to PDAC Commodes  LCDRevision Effective Date: 09/01/2009INDICATIONS AND LIMITATIONS OF COVERAGE AND/OR MEDICAL NECESSITY: Removed: Reference to DMERCHCPCS CODES AND MODIFIERS:Added: GA and GZ modifiersRevised: KX modifierDOCUMENTATION REQUIREMENTS:Added: Instructions for the use of GA, GY and GZ modifiers. Policy ArticleRevision Effective Date: 09/01/2009 CODING GUIDELINES: Changed: SADMERC to PDAC Enteral Nutrition Policy ArticleRevision Effective Date: 07/01/2009 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:Added: Instructions for delivery of supplies. Changed: DMERC to DME MAC CODING GUIDELINES:Clarified: Definition for supply kit codes B4034-B4036.Changed: SADMERC to PDAC Epoetin LCDRevision Effective Date: 09/01/2009CMS NATIONAL COVERAGE POLICY:Added: CMS Pub. 100-2, Medicare Benefit Policy Manual, Chapter 15, Section 50.5.2HCPCS CODES AND MODIFIERS:Added: GY modifierRevised: KX modifierDOCUMENTATION REQUIREMENTS:Added:  Instructions for use of GY modifier Policy ArticleRevision Effective Date: 09/01/2009CODING GUIDELINES:Changed: SADMERC to PDAC Eye Prostheses Policy ArticleRevision Effective Date: 07/01/2009 CODING GUIDELINES:Revised: RT/LT instructions. Changed: SADMERC to PDAC Facial Prostheses Policy ArticleRevision Effective Date: 07/01/2009 CODING GUIDELINES:Revised: RT/LT modifier instructions Changed: SADMERC to PDAC Home Dialysis Supplies and Equipment  LCDRevision Effective Date: 09/01/2009 HCPCS CODES AND MODIFIERS:Added: GY modifier Revised: KX modifierDOCUMENTATION REQUIREMENTS:Added: Instructions for use of GY modifier. Policy ArticleRevision Effective Date: 09/01/2009 CODING GUIDELINES: Changed: SADMERC to PDAC Positive Airway Pressure (PAP) Devices for Obstructive Sleep Apnea LCDRevision Effective Date:  09/01/2009HCPCS CODES AND MODIFIERSAdded : GA and GZ modifiers Revised: KX ModifierDOCUMENTATION:Added:  Information about the required use of GA, GZ or KX on claim lines for PAP devices and/or accessories. Respiratory Assist Devices (RAD) LCDRevision Effective Date: 09/01/2009 HCPCS CODES AND MODIFIERS: Added: GA and GZ modifiers Revised: KX modifier DOCUMENTATION REQUIREMENTS: Added: Instructions for the use of GA and GZ modifiers Policy ArticleRevision Effective Date: 09/01/2009 CODING GUIDELINES: Changed: SADMERC to PDAC Note: The information contained in this article is only a summary of revisions to LCDs and Policy Articles.  For complete information on any topic, you must review the LCD and/or Policy Article.

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.  To unsubscribe/change profile: click here.

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DME MAC A News for June 25, 2009 - PAP and RAD Devices LCDs Revised

 

NHIC, Corp.DME MAC A ListServe

For Immediate Release

 

June 25, 2009 PAP and RAD Devices LCDs RevisedThe Positive Airway Pressure (PAP) devices and Respiratory Assist Devices (RAD) local coverage determination (LCD) have been revised, effective for dates of service on or after September 1, 2009. The revised information is in the Documentation Section and outlines the use of additional modifiers to indicate that an item is not medically necessary and whether or not a waiver of liability statement (i.e., Advance Beneficiary Notice or ABN) is on file.Over the coming months, LCDs that include use of the KX modifier will be updated to incorporate instructions for the use of the GA, GZ or GY modifiers. If the patient meets the criteria for use of the KX modifier but the supplier forgets to include it on the claim line, currently the supplier may request a reopening of the claim. This procedure requires manual intervention by the DME MAC and is responsible for a substantial workload for the contractor. Therefore, the DME MACs are implementing system edits that will reject a claim line if the supplier does not indicate that the beneficiary either meets or does not meet the requirements that are specified in each medical policy. The contractors will use the presence of a GA, GZ, or GY modifier as an indication that coverage criteria are not met. If a claim line is rejected, the supplier may resubmit the claim line with the appropriate modifier. Requesting a reopening will no longer be an option.Since the KX modifier has a different definition depending on the LCD in question, suppliers should read the revised LCDs carefully to understand the proper use of the additional modifiers GA, GZ or GY. Further instructions and details will be published with each LCD revision.

 

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DME MAC A News for June 25, 2009 - Mid-Week Updates

 

NHIC, Corp.DME MAC A ListServe

For Immediate Release

 

June 25, 2009 Weekly What's New The following publications have been posted to the DME MAC A What's New page:Registration for the 2009 DME MAC Jurisdiction A Symposiums is now Open The 2009 DME MAC Jurisdiction A Symposium Speakers & Exhibitors page has been updated LCD and Policy Article Revisions - Summary for June 25, 2009 PAP and RAD Devices LCDs Revised The following Local Coverage Determinations (LCDs) / Medical Policies have been revised:Automatic External Defibrillators (L13613)Canes and Crutches (L11496)Cervical Traction Devices (L15844)Cold Therapy (L5038)Commodes (L11497)Enteral Nutrition (L5041)Epoetin (L11463)Eye Prostheses (L11529)Facial Prostheses (L5046)Home Dialysis Supplies and Equipment (L11498)Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L11528)Respiratory Assist Devices (L11504) For more information visit: http://www.medicarenhic.com/dme/dme_whats_new.shtml

 

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DME MAC A News for June 25, 2009 - Registration is Now Open for the 2009 DME MAC Jurisdiction A Symposiums

 

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For Immediate Release

 

June 25, 2009 Registration Now Open!! 2009 DME MAC Jurisdiction A SymposiumsRegistration is now open for the DME MAC Jurisdiction A Educational Symposiums. Registration will be taken on a first come, first served basis until maximum capacity has been reached for each location. We are excited to be offering a dynamic range of topics and speakers. Some key speakers are from the Centers for Medicare and Medicaid Services (CMS), Competitive Bidding Implementation Contractor (CBIC), Comprehensive Error Rate Testing (CERT) Contractor, National Supplier Clearinghouse (NSC), and the Recovery Audit Contractor (RAC). In addition, the DME MAC A Medical Director will also be speaking during the general lunch session. Attendees will have the opportunity to interact directly with these various Medicare Contractors as well as State and National DMEPOS Associations in order to enhance their educational experience and get the most out of this excellent opportunity.A Symposium Web page is available on the DME MAC A Web site, which can be accessed at: http://www.medicarenhic.com/dme/symposium/Symposium_General_Information.shtmlThis web page contains details and registration information. ListServe messages will be issued each time this page is updated. NHIC, Corp. DME MAC Jurisdiction A would like to extend this invitation to all interested Jurisdiction A suppliers.Please forward this information to all applicable individuals and keep watching for more details!We look forward to seeing you there!

 

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DME MAC A News for June 25, 2009 - LCD and Policy Article Revisions - Summary for June 25, 2009

 

NHIC, Corp.DME MAC A ListServe

For Immediate Release

 

June 25, 2009 LCD and Policy Article Revisions - Summary for June 25, 2009Outlined below are the principal changes to several DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. Please review the entire LCD and each related Policy Article for complete information.  Automatic External Defibrillators     LCD           Revision Effective Date: 09/01/2009           HCPCS MODIFIERS:               Added: GA and GZ modifiers.               Revised: KX modifier.           DOCUMENTATION REQUIREMENTS:               Added: Instructions for use of GA and GZ modifiers.     Policy Article           Revision Effective Date: 09/01/2009           CODING GUIDELINES:               Changed: SADMERC to PDAC. Canes and Crutches     Policy Article           Revision Effective Date: 07/01/2009           CODING GUIDELINES:               Changed: SADMERC to PDAC. Cervical Traction Devices     LCD           Revision Effective Date: 09/01/2009           INDICATIONS AND LIMITATIONS OF COVERAGE:               Removed: E0856 from range of covered codes.           HCPCS CODES AND MODIFIERS:               Added: GA and GZ modifiers.               Revised: KX modifier.           DOCUMENTATION REQUIREMENTS:               Added: Instructions for the use of GA and GZ modifiers.     Policy Article           Revision Effective Date: 09/01/2009           CODING GUIDELINES:               Changed: SADMERC to PDAC. Cold Therapy     Policy Article           Revision Effective Date: 07/01/2009           CODING GUIDELINES:               Changed: SADMERC to PDAC. Commodes     LCD           Revision Effective Date: 09/01/2009           INDICATIONS AND LIMITATIONS OF COVERAGE AND/OR MEDICAL NECESSITY:               Removed: Reference to DMERC.           HCPCS CODES AND MODIFIERS:               Added: GA and GZ modifiers.               Revised: KX modifier.           DOCUMENTATION REQUIREMENTS:               Added: Instructions for the use of GA, GY and GZ modifiers.     Policy Article           Revision Effective Date: 09/01/2009           CODING GUIDELINES:               Changed: SADMERC to PDAC. Enteral Nutrition     Policy Article           Revision Effective Date: 07/01/2009           NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:               Added: Instructions for delivery of supplies.               Changed: DMERC to DME MAC.           CODING GUIDELINES:               Clarified: Definition for supply kit codes B4034-B4036.               Changed: SADMERC to PDAC. Epoetin     LCD           Revision Effective Date: 09/01/2009           CMS NATIONAL COVERAGE POLICY:               Added: CMS Pub. 100-2, Medicare Benefit Policy Manual, Chapter 15, Section 50.5.2.           HCPCS CODES AND MODIFIERS:               Added: GY modifier.               Revised: KX modifier.           DOCUMENTATION REQUIREMENTS:               Added: Instructions for use of GY modifier.     Policy Article           Revision Effective Date: 09/01/2009           CODING GUIDELINES:               Changed: SADMERC to PDAC. Eye Prostheses     Policy Article           Revision Effective Date: 07/01/2009           CODING GUIDELINES:               Revised: RT/LT instructions.               Changed: SADMERC to PDAC. Facial Prostheses     Policy Article           Revision Effective Date: 07/01/2009           CODING GUIDELINES:               Revised: RT/LT modifier instructions.               Changed: SADMERC to PDAC. Home Dialysis Supplies and Equipment     LCD           Revision Effective Date: 09/01/2009           HCPCS CODES AND MODIFIERS:               Added: GY modifier.               Revised: KX modifier.           DOCUMENTATION REQUIREMENTS:               Added: Instructions for use of GY modifier.     Policy Article           Revision Effective Date: 09/01/2009           CODING GUIDELINES:               Changed: SADMERC to PDAC. Positive Airway Pressure (PAP) Devices for Obstructive Sleep Apnea     LCD           Revision Effective Date: 09/01/2009           HCPCS CODES AND MODIFIERS               Added: GA and GZ modifiers.               Revised: KX modifier.           DOCUMENTATION:               Added: Information about the required use of GA, GZ or KX on claim lines for PAP devices and/or accessories. Respiratory Assist Devices (RAD)     LCD           Revision Effective Date: 09/01/2009           HCPCS CODES AND MODIFIERS:               Added: GA and GZ modifiers.               Revised: KX modifier.           DOCUMENTATION REQUIREMENTS:               Added: Instructions for the use of GA and GZ modifiers.     Policy Article           Revision Effective Date: 09/01/2009           CODING GUIDELINES:               Changed: SADMERC to PDAC.Note: The information contained in this article is only a summary of revisions to LCDs and Policy Articles. For complete information on any topic, you must review the LCD and/or Policy Article.

 

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Jurisdiction B News: PAP and RAD LCDs Revised – GA, GZ, and GY Modifiers

 

PAP and RAD LCDs Revised – GA, GZ, and GY Modifiers The Positive Airway Pressure (PAP) devices and Respiratory Assist Devices (RAD) local coverage determination (LCD) have been revised, effective for dates of service on or after September 1, 2009.  The revised information is in the Documentation Section and outlines the use of additional modifiers to indicate that an item is not medically necessary and whether or not a waiver of liability statement (i.e., Advance Beneficiary Notice or ABN) is on file. Over the coming months, LCDs that include use of the KX modifier will be updated to incorporate instructions for the use of the GA, GZ or GY modifiers.  If the patient meets the criteria for use of the KX modifier but the supplier forgets to include it on the claim line, currently the supplier may request a reopening of the claim.  This procedure requires manual intervention by the DME MAC and is responsible for a substantial workload for the contractor.  Therefore, the DME MACs are implementing system edits that will reject a claim line if the supplier does not indicate that the beneficiary either meets or does not meet the requirements that are specified in each medical policy.  The contractors will use the presence of a GA, GZ, or GY modifier as an indication that coverage criteria are not met.  If a claim line is rejected, the supplier may resubmit the claim line with the appropriate modifier.  Requesting a reopening will no longer be an option. Since the KX modifier has a different definition depending on the LCD in question, suppliers should read the revised LCDs carefully to understand the proper use of the additional modifiers GA, GZ or GY.  Further instructions and details will be published with each LCD revision.

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.  To unsubscribe/change profile: click here.

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