Summer 2007 DAC Update

Spring 2009 Jurisdiction D DAC POE Update March 24, 2009

Educational Events Attended National Home Infusion Conference-March 1-3-over 1,000 suppliers attended CAMPS-March 4-5 Nebraska State Meeting-March 10

Upcoming Events  PAMES-May 5-6  VGM Heartland-June 8-11

Web Workshops Completed Glucose Monitors Advance Beneficiary Notice of Noncoverage Wheelchair Options and Accessories Positive Airway Pressure Devices Documentation Prior to Claim Submission Reopening and Appeals Process

Upcoming Workshops 04/02/09 2:00 pm CT Oxygen and Oxygen Equipment 04/07/09 10:00 am CT Oxygen and Oxygen Equipment 04/14/09 10:00 am CT Documentation Prior to DME Claim Submission 04/28/09 10:00 am CT Oxygen and Oxygen Equipment 04/30/09 2:00 pm CT Oxygen and Oxygen Equipment

Face-to-Face Workshops NAS is offering face-to-face workshops in April through early June. In the three hour morning session we will be discussing Medicare and DME Basics, covering subjects such as general DME coverage, benefit and fee schedule payment categories, consolidated billing, medical policies, documentation requirements, modifiers, appeals and common denials. This is a great session for new billing staff.

In the three hour afternoon session, we will be discussing oxygen and positive airway pressure devices.

We will be offering these workshops in the following locations:

April: Fargo, St. Louis, Omaha, Salt Lake City, San Francisco May: Casper, Billings, Portland, Torrance and Pasadena, CA June: Anchorage

Each session is $20 and registration must be sent via mail, along with payment. The registration form is located on the training/events page on our website, on the Face-to- Face Workshops page.

of 5 Ask the Contractor Teleconferences  Held quarterly for large suppliers and small suppliers in 2009  Next small supplier ACT is May 20 at 3 pm CT  June 23 is next quarterly ACT-also at 3 pm CT  All 2009 calls listed on ACT web page  Next CMS DME Open Door Forum is April 1, 2009 at 2 PM ET

POE Advisory Group  Latest meeting held on March 12, focused on CERT education, along with top reason for claim errors, along with top reason for calls and written inquiries received by the Supplier Contact Center  Next meeting is June 18  Just recruited some new members so membership is looking pretty good

Supplier Manual  Rewrite project is still in process-will be focus in first quarter 2009 with goal to have all chapters completed by end of March.

Online Learning Center  Glucose monitors, therapeutic shoes and hospital beds are courses next in line for development as these are areas of high CERT error rates.  Oxygen lesson is under review and will be coming soon.

Website Updates  Dedicated page on oxygen-all latest information on this topic located under Publications/Upcoming Changes/Oxygen  Just published article on glucose documentation requirements for physicians  New FAQs added-look for March 2009 updates  Rearranged appeals page based on type of appeals to make it easier to find information  More specialty pages will be coming

Accreditation Deadlines CMS wants to ensure that DMEPOS suppliers have ample time to complete the accreditation process and thus receive an accreditation decision by the September 30, 2009, deadline. In order to meet this deadline, CMS is encouraging all enrolled DMEPOS suppliers, except those eligible professionals and other persons exempted by law, to submit a complete accreditation application to an accreditation organization by January 31, 2009. If you have missed this deadline, submit your accreditation application ASAP. We encourage suppliers to verify accreditation information is on file with the NSC. If this has not been completed, submit the CMS 855S form and complete section 2F.

Watch for an article from NAS on how to notify the NSC of your accreditation information.

Recovery Audit Contractor On February 4, 2009 the parties involved in the protest of the award of the Recovery Audit Contractor (RAC) contracts settled the protests. The settlement means that the stop work order has been lifted and CMS will now continue with the implementation of the Page 2 of 5 RAC program. Under the program, the four RACs will contract with subcontractors to supplement their efforts. PRG-Schultz, Inc., the former RAC contractor, for Jurisdiction D will serve as a subcontractor to the current RAC contractor, HealthDataInsights. Each subcontractor has negotiated different responsibilities in each region, including some claim review.

The phone # for HealthDataInsights, Inc, is 866-376-2319. Email is [email protected]. See cms.hhs.gov/rac, Recent Updates, for a list of scheduled outreach.

Competitive Bidding Interim final rule with comment period (IFC) implementing certain limited changes, required by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), to DMEPOS competitive bidding program effective date was postponed 60 days to 4/18/09. Comments were due by 3/17/09. See the competitive bidding section of our website, under Publications, Upcoming Changes, for the latest news. CBIC staff will also be in the Medtrade booth to answer questions.

Surety Bond On 12/29/08, CMS announced a final regulation requiring certain DME suppliers post a surety bond as a condition of new or continued Medicare enrollment. The regulation states that beginning 5/4/09, suppliers seeking to enroll or changing the ownership of a DMEPOS supplier must submit a $50,000 surety bond for each assigned NPI for which the DMEPOS supplier is seeking to obtain Medicare billing privileges. Existing DMEPOS suppliers must submit to the NSC a $50,000 surety bond for each assigned NPI no later than 10/2/09.

The NSC website has some FAQs on this topic and they just published a March 2009 newsletter with information on surety bonds.

The final regulations are effective 3/3/09 and were not delayed pending the Obama administration review. Some companies or organizations that supply DMEPOS are exempt from the surety bond requirements, i.e., certain physician and non-physician practitioners, physical therapists, occupational therapists, state-licensed orthotic and prosthetic personnel and government-owned suppliers.

NAS will be creating a web page for housing all information on this topic soon under Upcoming Changes on our Publications web page. The NSC also published great FAQs on this topic in their March 2009 newsletter.

ICD-10 Final rule published on 1/16/09 pushes back the implementation date for ICD-10- to 10/1/2013. ANSI 5010 pushed back to 1/1/2012. See the ICD-10 Upcoming Changes web page for new information.

Oxygen All of the information on this subject is located on our Publications web page, in the Upcoming Changes section. We will have links to the CMS publications, along with the most pertinent information categorized for easy reference. We most recently published an

of 5 article on how to correctly bill for oxygen contents. Watch the NAS website for more oxygen Frequently Asked Questions.

Other New Important Information

New Repair Codes Effective April 1, 2009

To distinguish between the repair or non-routine service of beneficiary-owned DME and oxygen equipment, two new "K" codes are effective for claims with dates of service on or after April 1, 2009. E1340 will no longer be a valid code for labor for repair for dates of service on/after April 1, 2009.

K0739 Repair or Non-routine Service for Durable Medical Equipment Other than Oxygen Equipment Requiring the Skill of a Technician, Labor Component, Per 15 Minutes

K0740 Repair or Non-routine Service for Oxygen Equipment Requiring the Skill of a Technician, Labor Component, Per 15 Minutes

The new non-covered code K0740 should be to indicate the labor associated with the repair of stationary or portable oxygen equipment.

Supplies and Accessories Used with Beneficiary Owned Equipment

Effective for claims submitted on or after April 1, 2009, for supplies and accessories used with beneficiary-owned equipment, all of the following information must be submitted in Item 19 on the CMS-1500 claim form or in the NTE segment for electronic claims:

 HCPCS code of base equipment; and,  A notation that this equipment is beneficiary-owned; and,  Date the patient obtained the equipment.

Claims for supplies and accessories must include all three pieces of information listed above. Claims lacking any one of the above elements will be denied for missing information of whether the patient owns the equipment that requires the part or supply.

Medicare requires that supplies and accessories only be provided for equipment that meets the existing coverage criteria for the base item. In addition, should the supply or accessory have additional, separate criteria, these must be met also. In the event of a documentation request from the contractor or a redetermination request, suppliers should provide information justifying the medical necessity for the base item and the supplies and/or accessories. Refer to the applicable Local Coverage Determination(s) and related Policy Article(s) for information on the relevant coverage, documentation and coding requirements.

Reminders:  Take the website survey and let us know how you like our website updates and changes.

of 5  If you receive a Medicare Contractor Provider Satisfaction Survey, NAS would also appreciate you taking a few minutes to complete this survey on our performance.  KE modifier is only to be used on wheelchair accessory codes, not the actual wheelchair base.  Effective April 6, 2009, the last five digits of the Tax Identification Number or TIN will become an authentication element for release of any information from the IVR or our contact center. Reference MLN Matters 6139 for more information. Written inquiries also require an authentication element.  NAS has seen an increase in claims where the RA modifier is used inappropriately. The RA modifier is described as replacement of a DME item, due to loss, irreparable damage, or when the item has been stolen. The meaning of the replacement modifier has not changed and the following rules still apply:  The RA modifier should only be used on the first month rental claim for a replacement item.  A narrative explaining the reason for the replacement, if it happens prior to the useful lifetime of the item being reached, i.e., five years for most DMEPOS, is required on the claim.  A new order or Certificate of Medical Necessity (CMN), if applicable, is required. If the RA modifier is reported inappropriately, the claim will be denied as unprocessable.

Medtrade o Booth 932 –all DME MACs represented, along with CEDI, CBIC and NSC o DME MAC Provider Outreach and Education staff will present at a one‐ hour “Medicare Updates” session on 3/26 from 9:45 – 10:45 am if you want to hear news from the other DME MACs.