December 1997
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DMERC Medicare News DMERC Region A Service Office • P. O . B o x 6 8 0 0 • Wilkes-Barre, PA 18773-6800 • Phone (717) 735-9445 Change in Processing Systems he Region A DMERC would like to inform the supplier community of a Health TCare Financing Administration (HCFA) directed change in processing systems. Region A will transition to theVIPS Medicare System (VMS). VIPS is the processing system utilized by the other Durable Medical Equipment Regional Carriers. The DMERC will continue to work closely with HCFA to ensure a smooth transition from our current system to VMS. As part of the transition, the DMERC is in the process of developing an outreach program to educate those that would be affected by this change. This will include Ask the Doc educational seminars. Suppliers have begun to generate questions to the DMERC regarding this transition n the next issue of the and the DMERC will continue to provide updates as we proceed with implementation DMERC Medicare News I of VMS. Further information on this topic will be distributed in upcoming newsletters, we will be introducing a col- supplier notices, on the automated response unit (ARU) and the electronic bulletin umn entitled, “Ask the Doc?”. board (BBS). This column will consist of questions and answers re- PLEASE NOTE: Region A previously published a “Supplier Alert” dated, garding Medical Policy. Our September 19, 1997, announcing that we will transition to the VIPS processing system. Medical Director, Dr. Paul There has been a change in the date of transition. We will not transition on April 1, 1998 Hughes,willhostthisnew as published. The DMERC will notify the supplier community of the transition date once feature. it is confirmed. Educational seminars will be planned in accordance with the revised transition date. If you have an issue which you would like addressed, please send it to: DMERCs Attend Medtrade Show United HealthCare Region A DMERC he four Durable Medical Equipment Regional Carriers (DMERCs) attended the Attn.: Editor - DMERC Medtrade show that was held October 7-10 in New Orleans, LA. The DMERCs Medicare News T once again shared exhibit space. This joint effort by the DMERCs gave suppliers an PO Box 6800 opportunity to interact with all four DMERCs in one location. Our experience at the Wilkes-Barre, PA 18773-6800 show was positive. The majority of suppliers, manufacturers and other healthcare RETIREDprofessionals were very pleased with the DMERCs attendence. The DMERCs recognize these functions as an ideal opportunity to offer continued availability to suppliers. Number 35 • December, 1997 IN THIS ISSUE Claim Processing Medical Policy ChangeinProcessingSystems.................1 Backup Equipment . 4 ESRDUpdate.......................... 15 Blood Glucose Monitors - Policy Revision . 3 HCFA1500Form........................ 15 Epoetin...............................5 Reminders............................ 15 ExtraWide/HeavyDutyHospitalBeds............3 InfusionPumps/ChangeofDrug...............4 JawMotionDevices.......................6 Electronic Data Interchange Nebulizer Equipment Codes: No Products . 3 AccelerateSoftware...................... 21 AccelerateSoftwareOrderForm............... 22 Miscellaneous BBSMailBulletins....................... 17 AsktheDoc............................1 BillerCodeRejects....................... 21 CMNsandPhysicianCoercion................ 41 Change of Address . 16 PhoneFAQs(FrequentlyAskedQuestions)........ 42 DMERC Regions A, B, C, and D – Certified and SupplierManuals........................ 41 Selected Certified Vendor Lists . 22 EDI Facts . 16 Outreach ElectronicRemittanceNotices(ERN)............ 17 Electronic Remittance Notices (ERN Version 2.01) . 17 CongressionalBeneficiaryOutreach............. 28 Interested in a Cost Effective and Accurate Method of DMERCsAttendMedtradeShow...............1 SubmittingDMEPOSClaims?.............. 21 EducationalSeminarsinRetrospect............. 27 ImportantNSF3.01Information............... 16 Ombudsmen and Medical Director Attend InternetAccount........................ 18 New England Medical Equipment Dealers Association’sAnnualMeeting.............. 29 NewAcknowledgmentReports............... 17 SeminarRegistrationFee................... 27 OptionstoCheckClaimStatus................ 17 The BBS Supplier Questionnaire System . 18 Pricing TransferClaims......................... 16 ZippedEDIFiles........................ 17 Balanced Budget Act of 1997 - Fee Schedule Changes . 14 Correction............................ 14 Hearings/Appeals Supplier Notices AppealsAnalysisProgram.................. 30 Supplier Notice 97-24: Billing Clarifications - FairHearingReminders.................... 32 SurgicalDressings.................... 33 HearingRequestChecklist.................. 33 Supplier Notice 97-25: Product/Process Focus Groups . 34 The Appeals Process . Reconsiderations, Supplier Notice 97-26: Attention! Accelerate HearingsandMore.................... 30 SoftwareUsers...................... 38 SupplierNotice97-27:NewOxygenCMN......... 38 HCFA Common Procedure Coding System Supplier Notice 97-28: Acknowledgment Reports . 38 Supplier Notice 97-29: Date of Service/Date of Category IV and V Enteral Nutrients - HCPCS Coding . 12 Delivery/DataofDischarge............... 38 DeletedCodes......................... 10 Supplier Notice 97-30: New Code for Methotrexate . 39 Modified1998HCPCSCodes................. 10 SupplierNotice97-31:SupplierAlert............ 39 New Codes Effective for Dates of Service On or Supplier Notice 97-32: End Stage Renal Disease AfterJanuary1,1998................... 7 CoverageUpdate..................... 39 Correct Code for “Introl” Bladder Neck Supplier Notice 97-33: Non-Licensed Pharmacy . 40 SupportProsthesis....................RETIRED 7 SupplierNotice97-34:SuretyBonds............ 40 2 Region A DME Medicare News No. 35 • December, 1997 Medical Policy Nebulizer Equipment Codes: which accessories are included in the al- No Products lowance for the monitor. It also incorporates a code change from the 1997 n the March 1997, DME Medicare HCPCS update. INewsletter (page 7) , the article “Pro- posed Nebulizer Equipment Coding This revision does not include ex- panded coverage for glucose monitors Guide,” requested that manufacturers that is contained in the provisions of the submit to the SADMERC those nebulizer Balanced Budget Act of 1997. Details of compressors and their technical specifica- the possible expanded coverage are being tions which they believed should be addressed by HCFA and will be publish- coded as either E0565, K0269,orK0501. ed when they are available. It is • E0565 is a pneumatic aerosol com- important to continue to add the ZX modifier to codes for the monitor, acces- pressor which can be set for pres- sories, and supplies, but only when the sures above 30 psi at a flow rate of order indicates that the patient is a dia- 6-8 liters/minute, and is capable of betic and is being treated with insulin continuous operation injections. • K0269 is a pneumatic aerosol com- pressor which can be set for pres- Extra Wide/ Heavy Duty sures above 30 psi at a flow rate of Hospital Beds 6-8 liters/minute, but is capable only of intermittent operation. tandard hospital beds are billed with • K0501 is a portable compressor Scodes E0250-E0266 or E0290-E0297. which delivers a fixed, low pres- Hospital beds with a mattress that is sure and is used with a small vol- wider than 36” and that can support a ume nebulizer. It must have bat- patient weighing more than 350 pounds tery or DC power capability and must be submitted using miscellaneous may have an AC power option. code E1399. Initial claims for this type bed must be accompanied by: 1) a Hospi- The SADMERC reports having re- tal Bed CMN which must include the ceived no product descriptions in patient’s weight and height, 2) the manu- response to this article. Therefore, the facturer and model/product name/ DMERC concludes that there are no prod- number of the bed, and 3) any additional ucts that meet these descriptions. Thus, information which documents the medi- for dates of service on or after 4/1/98 cal necessity for the bed (e.g., reasons why claims for any of these three codes will be a standard hospital bed is not adequate, rejected as invalid for submission to the etc.). Items 2 and 3 must be entered in the DMERC. HA0 record of an electronic claim or at- tached to a paper claim. These beds will Blood Glucose Monitors - be considered capped rental items and Policy Revision therefore payment will only be made on a rental basis. The appropriate modifier revision of the policy is included (KH, KI, or KJ) must be used and the Ain the accompanying Supplier rent/purchase option must be offered in Manual Update. This revision clarifies the tenth rental month, as with all capped RETIREDrental items. Region A DME Medicare News No. 35 • December, 1997 3 Infusion Pumps / Change of ment. The payment for the primary piece Drug of equipment would include the cost of that piece of equipment and the frequent and substantial servicing plan that the f the beneficiary begins using an infu- supplier must provide to ensure that the Ision pump for one drug and patient always has a piece of equipment subsequently the drug is changed or an- that is in working order. If the backup other drug is added, a revised Certificate equipment is billed, it will be denied as of Medical Necessity (CMN) must be sub- not being reasonable and necessary. mitted for use of the pump with the new or additional drug. Backup equipment must be distin- guished from multiple medically