DAC POE Update October 13, 2009



DAC POE Update October 13, 2009

Policy Updates

As LCD and Policy Article are being reviewed, references to the SADMERC are being changed to the PDAC.

LCD KX, GZ & GA modifier instruction changes effective 12-1-09:

• Speech Generating Devices 

• Transcutaneous Electrical Nerve Stimulation (TENS)

• Ankle-Foot/Knee-Ankle-Foot Orthosis

• Knee Orthoses

• Nebulizers (K0730 and Q4080) (removed KX requirement for J7605 & J7606)

• Oral Antiemetic Drugs

• Pressure Reducing Support Surfaces - Group 1

• Urological Supplies (KX or GY instructions only because of statutory coverage criteria…if the statutory criteria not met denies non-covered (GY)

• Walkers

• Wheelchair Seating

Remember the DME MACs will use the presence of a KX, GA, GZ, or GY modifier to indicate whether the coverage criteria are or are not met. The DME MACs have implementing system edits that will reject a claim line if the supplier does not include one of these modifiers as specified in each LCD. If a claim line is rejected, the supplier must resubmit the claim line with the appropriate modifier. Requesting a reopening to correct a claim that is missing one of these modifiers will no longer be an option.

Therapeutic Shoes for Persons with Diabetes Policy Article

Revision Effective Date: 9-1-09

Revised: Billing instructions for the RT and LT modifiers. (lt rt 2 units of service)

Revised: Statement concerning which products billed with code A5513 must have PDAC Coding Verification Review.

There are two categories of products that are billed with code A5513:

• Inserts that are custom fabricated by a manufacturer/central fabrication facility and then sent to someone other than the patient. These items may be billed using code A5513 only if they are listed on the PDAC web site.

• Inserts that are custom fabricated from raw materials that are dispensed directly to the patient by the entity that fabricated the insert. These items do not have to be listed on the PDAC web site in order to be billed using code A5513. However, the supplier must provide a list of the materials that were used and a description of the custom fabrication process on request.

Surgical Dressings Policy Article

Revision Effective Date: 01/01/2009 (September 2009 Publication)

CODING GUIDELINES:

Added: A6545 (non-elastic compression wrap) to list of codes requiring the AW modifier

Added: A6545 to list of codes requiring the RT and/or LT modifier(s)

Revised: RT/LT modifier instructions (ltrt 2 units of service)

Transcutaneous Electrical Nerve Stimulation (TENS)

Revision Effective Date: 12/01/2009

INDICATIONS AND LIMITATIONS OF COVERAGE:

Revised: Additional supply quantities denial statement

• Quantities of supplies greater than those described in the policy as the usual maximum amounts will be denied as not medically necessary.

o A4557 LEAD WIRES, (E.G., APNEA MONITOR), PER PAIR

o A4595 ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G. TENS, NMES)

Wheelchair Seating LCD

Revision Effective Date: 12/01/2009

INDICATIONS AND LIMITATIONS OF COVERAGE:

Added: Hemiplegia, Huntington's chorea, idiopathic torsion dystonia, and cerebral palsy to the list of covered conditions for skin protection seat cushions

Added: Above knee amputations, osteogenesis imperfecta, and transverse myelitis to the list of covered conditions for positioning seat and back cushions and positioning accessories

ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:

Added: Corresponding ICD-9 codes

Moved: 359.0, 359.1 from second group of codes to the first group of codes for E2607, E2608, K0736, K0737

Competitive Bid Updates

CMS has been conducting Open Door Forums. Last one was October 7, 2009

The bidding timeline includes a target bid window opening date of October 21, 2009. CMS is currently on schedule to meet this target date. The official opening of the 60-day bid window will be announced via a listserv (e-mail) message.

In order to avoid any overlap of the Round 1 Rebid contract period for mail-order diabetic supplies and a possible contract period resulting from a national mail-order competition, the Round 1 Rebid contract period for mail-order diabetic supplies will be two years. The contract period for all other Round 1 Rebid product categories will be three years.

The Competitive Bidding Implementation Contractor [pic](CBIC) is the focal point for bidder education. Please review this Website for important information, including bidding rules, user guides, frequently asked questions, policy fact sheets, checklists, and bidding information charts. The CBIC toll-free help desk, 1-877-577-5331, is open to help bidders with all of their questions and concerns. All suppliers interested in bidding are urged to sign up for E-Mail Updates on the home page of this Web site.

POE Updates

Face-to-Face Events

NAS begun our Fall/Winter (2009/2010) face-to-face workshops, titled Building the Foundation for Success. These have been very successful. We started out going to Phoenix, AZ (attendance approximately 120), Anchorage, AK (25) and Seattle, WA (100). The focus of these all-day workshops is to help suppliers gain the foundation needed for efficient billing and avoid errors. We will continue these workshops in various locations in 2010. Our agenda includes:

• Comprehensive Error Rate Testing (CERT)

o High Error Rate Policies

o Avoid Documentation Errors

o How to Appeal a Dispute

• Front End Errors

o Claim Error Report

o Know Your Payment Categories: Proper Use of Modifiers

• Successful Claim Filing-How to Avoid Denials

• Top Ten Telephone and Written Inquiries

WebEx Workshop

Since the last DAC meeting POE has conducted

• Two Workshops on Accessing LCD and Policy Articles

• Web Tool Workshop

• Refractive Lenses

• DME Reopening and Appeals

• Enteral

• Glucose Monitor and Testing Supplies

• Manual Wheelchair Bases

• Power Mobility Devices

• Oxygen and Oxygen Equipment

Upcoming workshops include:

• Putting the Pieces of DME Together October 27, 28, 29, 2009 - 11 am CT

• Therapeutic Shoes for Person with Diabetes November 5, 2009 - 3 pm CT

• Refractive Lenses November 19, 2009 - 3 pm CT

• Positive Airway Pressure Device December 1, 2009 - 3 pm CT

• Respiratory Assist Device December 3, 2009 – 3 pm CT

Association Events

• Big Sky AMES September 16-18

• AOPA September 20-23

• MAMES September 30-October 2

Ask the Contractor Teleconference (ACT)

• Small Supplier ACT August 19, 2009

o 15 Q&A posted to the Training and events tab of our Web site

• General ACT September 1, 2009

o 23 Q&A posted

• Enteral ACT Tentatively scheduled for November 10, 2009

• Small Supplier ACT November 12, 2009

• General ACT scheduled for December 15, 2009

General Updates

Next CMS Open Door Forum is scheduled for October

Date: Wednesday, October 21, 2009

Start Time: 2 p.m. ET

To participate by phone:

Dial: 1-800-837-1935 & Reference Conference ID: 31208403

Persons participating by phone are not required to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Encore: 1-800-642-1687; Conference ID# 31208403

Encore is an audio recording of this call that can be accessed by dialing 1-800-642-1687 and entering the Conference ID, beginning two hours after the call ends and will expire after three business days.

H.R. 3663 Extends Accreditation Deadline for Pharmacies Posted 10-9-09

To December 31, 2009

• Pharmacies that were not accredited prior to the October deadline are not subject to the revocation of Medicare billing privileges at this time.

• Any pharmacies that submitted a voluntary termination that now wish to withdraw this request, must submit a letter to the NSC signed by the authorized official.

• The letter MUST be received by the NSC no later than October 23, 2009.

• Letters may be faxed to the NSC by geographic location.

o East Team - 803-382-2405

o Central Team - 803-382-2408

o West Team - 803-382-2406

Male External Catheter - A4326 - Coding and Utilization Guidelines Posted 10-7-09

Code A4326 describes a special type of male ex-dwelling catheter (A4326 - Male external catheter with integral collection chamber, any type, each).

Products described by this code are made of plastic or rubber. They are designed to be washed and reused. One product described by this code is the AlphaDry System by AlphaDry Medical. The manufacturer's recommendation is that this product be replaced every 15 days.

Effective for claims submitted on or after November 1, 2009, the only products that may be billed using code A4326 are those that have undergone Coding Verification Review by the Pricing, Data Analysis, and Coding (PDAC) Contractor and that are listed in the DMECS Product Classification List on the PDAC web site.

Data analysis suggests that suppliers may be using this code incorrectly when they should be using code A4349 which is a standard male external catheter that is typically changed daily.

Suppliers who have incorrectly coded products should submit a voluntary refund to the DME MAC.

Questions concerning the coding of these products should be referred to the PDAC.

Oxygen FAQs Posted 10-7-09

Enteral FAQ Posted 9-28-09

AMDC Acknowledgement Letters

Starting October 12, 2009, NAS will no longer mail acknowledgement letters confirming the receipt of Advance Determination of Medicare Coverage (ADMC) requests. Allows our Medical Review Personnel a more focused approached in processing the requests and will dramatically increase our effectiveness in completing these within the 30 calendar day period. Suppliers will be able to call into the supplier contact center 3-5 business day after faxing or 5-7 business days after mailing an ADMC request, to confirm that NAS received the request.

New Offset Request Form Posted 10-1-09

To streamline processing of offset requests related to Recovery Audit Contractor (RAC) overpayments, NAS has created a unique offset request form and established a dedicated fax line to receive these requests.

NAS encourages suppliers to fill out the new Offset Request - RAC DME form when requesting that future claims payments be applied to overpayments initiated by Health Data Insights (HDI), the Recovery Audit Contractor (RAC) for Jursidiction D.

The form may be faxed to the dedicated RAC offsets fax line 1-866-640-9459. Suppliers are requested to include a copy of the related overpayment letter from HDI with the offset request.

MLN Matters 6421 - Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplier (DMEPOS) Suppliers Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)

Sent out on Email listserv 9-1-09 & 9-15-09.

MLN Matters 6528 - Compliance Standards for Consignment Closets and Stock and Bill Arrangements

Medicare allows Medicare enrolled DMEPOS suppliers to maintain inventory at a practice location owned by a physician or non-physician practitioner for the purpose of DMEPOS distribution when the following conditions are met by the DMEPOS supplier and verified by the NSC-MAC:

• The title to the DMEPOS shall be transferred to the enrolled physician or non-physician practitioner’s practice at the time the DMEPOS is furnished to the beneficiary.

• The physician or non-physician practitioner’s practice shall bill for the DMEPOS supplies and services using their own enrolled DMEPOS billing number.

• All services provided to a Medicare beneficiary concerning fitting or use of the DMEPOS shall be performed by individuals being paid by the physician or non-physician practitioner’s practice, not by any other DMEPOS supplier.

• The beneficiary shall be advised that, if they have a problem or questions with the DMEPOS, they should contact the physician or non-physician practitioner’s practice, not the DMEPOS supplier who placed the DMEPOS at the physician or non-physician practitioner’s practice.

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