DMERC Medicare RETIRED News

DMERC

Medicare

News

DMERC Region A Service Office u P.O. Box 6800 u Wilkes-Barre, PA 18773-6800 u Phone (570) 735-9445 u umd.

RETIREDNumber56uDecember2000

Region A DMERC Spring 2001 Seminars and Workshops

Mark your calendars ? the Spring 2001 seminar and workshop schedules are set!

Seminars:

Region A will hold DMERC 101 seminars to cover the basic billing information that new suppliers and new office staff will need to understand in order to submit claims to the DMERC. Topics to be covered in DMERC 101 are: HCFA-1500 Form, Certificates of Medical Necessity (CMNs), Fraud and Abuse, and Electronic Billing.

Workshops:

The DMERC will also hold mobility and parenteral/enteral nutrition workshops. Both workshops will include a brief overview of the category, a review of the medical policy, a DMERC update and EDI information. These workshops will be held concurrently.

For more information, visit our web site at umd..

Mobility and Parenteral/Enteral Workshops

Dates

Locations

February 20, 2001

Holiday Inn by the Bay

88 Spring Street

Portland, ME

February 22, 2001

LaGuardia Marriott

102-05 Ditmars Blvd.

East Elmhurst, NY

February 27, 2001

Valley Forge Hilton

251 W. DeKalb Pike

King of Prussia, PA

March 1, 2001

Adams Mark Hotel

120 Church St.

Buffalo, NY

DMERC 101 Seminars:

Dates

Locations

March 1, 2001

The Screening Room

Century Plaza

3131 Sheridan Dr.

Buffalo, NY

March 7, 2001

Upstate Medicare Division

Phone Numbers 800-345-5050

718-565-8900

610-337-1200

716-845-5100

Registration Deadlines February 13, 2001

February 15, 2001

February 20, 2001

February 22, 2001

Registration Deadlines February 22, 2001

February 28, 2001

33 Lewis Rd

Binghamton, NY

To register, complete a registration form on page 3 for each attendee. Registrations are not accepted by telephone.

Table of Contents

Region A DMERC Spring 2001 Seminars and Workshops . . 1

Infusion Pumps: Inotropic Drug Monitoring / Epoprostenol . . 17

Region A DMERC Contacts . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Ostomy Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

DMERC Supplier Manuals . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Claims Processing for Breast Prosthesis . . . . . . . . . . . . . . . 19

Support Surfaces - Group 3 - Policy Revision . . . . . . . . . . . . 19

Billing Home Health Prospective Payment System (PPS) . . . . . . . . 4

Lower Limb Prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Routine Costs of Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . 6

Miscellaneous

Billing Correct Units of Service for Nebulizer Drugs . . . . . . . 9

Supplier Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

RETIRED 2001 DMEPOS Fee Schedule . . . . . . . . . . . . . . . . . . . . . . . . 9

Lightweight Wheelchairs - K0003 and K0004 . . . . . . . . . . . . 9 Revised Fee Schedule for Hydrogel Dressings . . . . . . . . . . . 10

HCPCS Year 2001 HCPCS Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Tracheostoma Valves and Heat and Moisture Exchangers . . 13 Rollabout Chairs (E1031) . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Speech Generating Devices - New Codes . . . . . . . . . . . . . . 14 Limb Orthoses - Code Narrative Changes . . . . . . . . . . . . . . 15 Ventilator Code Change -E0450 - Reminder . . . . . . . . . . . . . 15 Hip Orthosis and Related Devices . . . . . . . . . . . . . . . . . . . . . 16 Stump Support System K0048 . . . . . . . . . . . . . . . . . . . . . . . 16 L1690 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Pessaries: New Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Nutrients Administered Orally . . . . . . . . . . . . . . . . . . . . . . . . . 17 External Cardiac Defibrillators . . . . . . . . . . . . . . . . . . . . . . . . 17

Medical Policy Statement of Certifying Physician for Therapeutic Shoes Revised . . . . . . . . . . . . . . . . . . . . . . . . . 17

Medicare Secondary To Department of Labor . . . . . . . . . . . . 20 Comprehensive Error Rate Testing (CERT) . . . . . . . . . . . . . 21 Offset Information Requests . . . . . . . . . . . . . . . . . . . . . . . . . 21 The Hype About HIPAA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 COB Contractor Fact Sheet for Providers . . . . . . . . . . . . . . . 22

SADMERC Manufacturer Questions Regarding SADMERC Coding Decisions . . . . . . . . . . . . . . . . . . . . . . . . 24 L0430 Classification List . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 SADMERC Toll-Free HCPCS Coding Assistance . . . . . . . . . 24

Supplier Notices 3rd Quarter Update: Region A DMERC Drug Fees . . . . . . . . 25 Attention: Accelerate Software Users . . . . . . . . . . . . . . . . . . 28 Oral Anticancer Drug Fees . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Attention Accelerate Software Users . . . . . . . . . . . . . . . . . . . 29 Important Announcement Regarding DMERC Transition . . . 30 Attention EDI Submitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Progressive Corrective Action Claim Review . . . . . . . . . . . . 30 Breast Prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

HealthNow DMERC A HealthNow DMERC A Fax Accounting Accounting/MSP Fax Beneficiary Help Line Beneficiary Toll Free Help Line EDI Fax EDI Help Desk

Region A DMERC Contacts

570-735-9400 570-735-9402 570-740-9002 570-735-9594 570-735-7383 800-842-2052 570-735-9510 570-735-9429

Hearings Voice Mail Medicare Secondary Payer National Supplier Clearinghouse Professional Relations Professional Relations Fax Reconsiderations Fax SADMERC Supplier Help Line

570-735-9513 570-740-9001 866-238-9652* 570-735-9666 570-735-9442 570-735-9599 877-735-1326* 570-735-9445

Hearings Fax

570-735-9599 (new) * New toll-free numbers

This bulletin should be shared with all health care practitioners and managerial members of the provider/supplier staff. The bulletins are available at no cost from our website at umd..

2

DMERC Medicare News, No. 56 u December 2000

The DMERC reserves the right to cancel any seminar or workshop. If this occurs, attendees who have received confirmations will be notified by telephone. Please do not contact the meeting facility for seminar information; contact the Region A DMERC at 570-735-9406.

Parking Information

Please telephone the workshop facility for specific information regarding location and possible parking fees. Free parking is available for both DMERC 101 Seminar locations.

How to Register

Complete a registration form below for each attendee and mail or fax the registration to the DMERC as noted below.

RETIRED Mail:

HealthNow DMERC A P.O. Box 6800 Wilkes-Barre, PA 18773-6800 Attn: Seminar Registration

Fax:

570-735-9442 Attn: Seminar Registration

All attendees must be pre-registered. Due to limited space, registration is on a first come, first served basis. In the event that a particular seminar is filled to capacity, you will be notified by telephone.

Note: If you do not receive your confirmation within 5 days of the event you have registered for, please call our Professional Relations Unit at 570-735-9406. z

Complete a registration form for each person attending. Please type or print clearly.

Company: ___________________________________________________________________________________________

Supplier Number: _____________________________________________________________________________________

Address _____________________________________________________________________________________________

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Phone: ______________________________________________________________________________________________

Fax: ________________________________________________________________________________________________

Date of Seminar: _____________________________________________________________________________________

Event (circle one):

Mobility

Parenteral/Enteral

DMERC 101

Name of Attendee:____________________________________________________________________________________

Contact Name: _______________________________________________________________________________________

This bulletin should be shared with all health care practitioners and managerial members of the provider/supplier staff. The bulletins are available at no cost from our website at umd..

DMERC Medicare News, No. 56 u December 2000

3

Billing

Home Health Prospective Payment System (PPS)

MSN and Remittance messages. For DMERCs, those services included are certain non-routine medical supplies listed below.

All changes described below are effective for home health claims with dates on or after October 1, 2000.

MSN Message: "Medicare does not pay separately for this service."

RETIRED Background Information ? PPS

Consolidated Billing

The Balanced Budget Act of 1997 required consolidated billing of all home health services while a beneficiary is under a home health plan of care authorized by a physician. Consequently, billing for all such items and services will be made to a single home health agency (HHA) overseeing that plan.

The law states that payment will be made to the primary HHA whether or not the item or service was furnished by the agency, by others under arrangement to the primary agency, or when any other contracting or consulting arrangements existed with the primary agency, or "otherwise." Payment for all items is scheduled in the home health PPS episode payment that the primary HHA receives.

Types of services that are subject to the home health consolidated billing provision include: w Skilled nursing care; w Home health aide services; w Physical therapy; w Speech-language pathology; w Occupational therapy; w Medical social services; w Routine and non-routine medical supplies; w Medical services provided by an intern or resident-

in-training of a hospital, under an approved teaching program of the hospital, in the case of a HHA that is affiliated or under common control with that hospital; and w Care for homebound patients involving equipment too cumbersome to take to the home.

Carrier Claims Processing

The Common Working File (CWF) will reject claims for services that should not be billed separately when a patient is under an established 60-day home health Plan of Care (POC) episode. For Part B services, those ser-

(Message 16.32)

Remittance Message: "Claim/service denied/reduced because this procedure/service is not paid separately." (Message B15)

Non-Routine Medical Supplies (DMERCs)

When a beneficiary is in a 60-day episode, these items are included in the PPS episode payment. HHAs must bill for all supplies provided during the 60-day episode including those not related to the Plan of Care because of the consolidated billing requirements. The codes listed below were published in the Federal Register.

A4212 A4213 A4215 A4310 A4311 A4312 A4313 A4314 A4315 A4316 A4320 A4321 A4322 A4323 A4326 A4327 A4328 A4329 A4330 A4335 A4338 A4340 A4344 A4346 A4347 A4351

Non coring needle or stylet 20+ cc syringe only Sterile needle Insert tray w/o bag/cath Catheter w/o bag 2-way latex Cath w/o bag 2-way silicone Catheter w/bag 3-way Cath w/drainage 2-way latex Cath w/drainage 2-way silcne Cath w/drainage 3-way Irrigation tray Cath therapeutic irrig agent Irrigation syringe Saline irrigation solution Male external catheter Fem urinary collect dev cup Fem urinary collect pouch External catheter start set Stool collection pouch Incontinence supply Indwelling catheter latex Indwelling catheter special Cath index foley 2 way silicn Cath indw foley 3 way Male external catheter Straight tip urine catheter

vices include physical therapy (Type of Service W),

A4352

Coude tip urinary catheter

Speech-Language Pathology (Type of Service W) and

(Continued on page 5.)

Occupational Therapy (Type of Service U). Rejected

A4353

Intermittent urinary cath

claims will be returned as denials using the following

A4354

Cath insertion tray w/bag

This bulletin should be shared with all health care practitioners and managerial members of the provider/supplier staff. The bulletins are available at no cost from our website at umd..

4

DMERC Medicare News, No. 56 u December 2000

A4355 A4356 A4357 A4358 A4359 A4361 A4362 A4363 A4364 A4365 A4367 A4368 A4397 A4398 A4399 A4400 A4402 A4404 A4421 A4455 A4460 A4462 A4481 A4554 A4622 A4623 A4625 A4626 A4649 A5051 A5052 A5053 A5054 A5055 A5061 A5062 A5063 A5071 A5072 A5073 A5081 A5082 A5093 A5102 A5105 A5112 A5113 A5114 A5119 A5121 A5122 A5123 A5126 A5131 A5149

Bladder irrigation tubing

A6020

Collagen wound dressing

Ext ureth clmp or compr dvc

A6154

Wound pouch each

Bedside drainage bag

A6196

Alginate dressing 16 48 sq in

Ostomy face plate

A6199

Alginate drsg wound filler

Solid skin barrier

A6200

Compos drsg 1648 no bdr

Ostomy adhesive remover wipe

A6203

Composite drsg 16 48 sq in Contact layer 16 48 sq in Foam drsg 16 48 sq in w/o brdr Foam drg 16 48 sq in w/bdr Foam dressing wound filler Gauze 16 48 sq in w/bdr Gauze 16 48 in no w /sal w/ o b Gauze 16 48 sq in water / salne Hydrocolld drg 16 48 in w / o b Hydrocolld drg 16 48 in w / bdr Hydrocolld drg filler paste Hydrocolloid drg filler dry Hydrogel drg 1648 in w / o bdr Hydrogel drg 16 48 sq in w / b Hydrogel dressing, wound filler Absorpt drg 16 ................
................

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