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Jurisdiction B News: Request for Refill - Documentation

Request for Refill - Documentation   For all DMEPOS items that are provided on a recurring basis, suppliers are required to have contact with the beneficiary prior to dispensing a new supply of items.   (Contact with a caregiver/ designee also meets the requirements that are specified in this article.)   For items that the patient obtains at a retail store s... Read More..


Jurisdiction B News: National Government Services Transitions to US Bank

National Government Services Transitions to US Bank   Effective 08/30/2010, National Government Services transitioned to US Bank. Please note the new addresses for all Medicare Secondary Payer and Overpayment Recovery Unit refund checks. Please begin using the new mailing address information effective immediately.   This information will be updated on the N... Read More..


Jurisdiction B News: Workshop on Issues Related to Accountable Care Organization

FTC, HHS Office of Inspector General, and Centers for Medicare & Medicaid Services Announce Workshop on Issues Related to Accountable Care Organizations (201009-12)   Public Event to be Held at CMS Headquarters in Baltimore on October 5, 2010 On October 5, 2010, the Federal Trade Commission will co-host a workshop on several issues associated with Accountable Care Or... Read More..


Jurisdiction B News: Maintenance and Servicing Schedule Web Page Revamped

The Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) recently revamped the Maintenance and Servicing Schedule page available on our Web site. New maintenance and servicing schedules have been developed for oxygen, parenteral, and enteral pumps.   The new schedules will help suppliers determine when to begin billing for maintenance and servi... Read More..


Jurisdiction B News: CARC, RARC, and MREP Update

MLN Matters Number: MM7089 Related Changed Request (CR) #: 7089 Related CR Release Date: August 6, 2010 Effective Date: October 1, 2010 Related CR Transmittal #: R2019CP Implementation Date: October 4, 2010   Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update ... Read More..


Jurisdiction B News: DMEPOS Specialty Code for Ocularists

MLN Matters Number: MM6891 Related Changed Request (CR) #: 6891 Related CR Release Date: August 20, 2010 Effective Date: April 1, 2011 Related CR Transmittal #: R2030CP Implementation Date: April 4, 2010   New Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Specialty Code for Ocularists   ... Read More..


Jurisdiction B News: Oxygen and Oxygen Equipment Billing Questions

National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has noticed an increase in the number of calls to the Provider Contact Center regarding billing of oxygen claims. This article is intended to help clarify issues surrounding billing of oxygen equipment.   Replacement Oxygen Medicare covers the month... Read More..


DME MAC Jurisdiction C News

Follow-Up National Provider Call regarding ICD-10 Implementation in a 5010 Environment: The Centers for Medicare & Medicaid Services (CMS) will host a follow-up national provider conference call on "ICD-10 Implementation in a 5010 Environment" on September 13th. Subject matter experts will review basic information on both ICD-10 and 5010 and explain how they are interrelated. A question and a... Read More..


Jurisdiction B News: Suppliers Receiving Paper Checks and/or Remittances Be Aware!

Suppliers Receiving Paper Checks and/or Remittances Be Aware!   Suppliers receiving paper checks should know that electronic funds transfer (EFT) is now a requirement. Effective in May 2006, all new and current suppliers submitting a CMS-855S application to the National Supplier Clearinghouse (NSC) are required to receive their payments via EFT. Reenrollment with the NSC occurs... Read More..


Jurisdicton B News: PAP Documentation Requirement Revision – Ineffective Therapy on E0601

PAP Documentation Requirement Revision – Ineffective Therapy on E0601   Recently questions have been received by the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) medical directors regarding the requirements in the Positive Airway Pressure (PAP) local coverage determination (LCD) for documentation of ineffective therapy while on an E0601 device.  To cla... Read More..


Jurisdiction B News: Billing for Denial of Vancomycin Administered Via an External Infusion Pump

Billing for Denial of Vancomycin Administered Via an External Infusion Pump   National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has received questions regarding how to bill for denial of vancomycin being administered through an external infusion pump. If the beneficiary does not meet the coverage c... Read More..


Jurisdiction B News: Oral Anticancer Drugs – Policy Article Revision

Oral Anticancer Drugs – Policy Article Revision - Covered Diagnoses   In March 2010, a revised medical policy on Oral Anticancer Drugs was published with an effective date of June 1, 2010.  That policy revision defined the ICD-9 diagnosis codes for which each drug would be covered.  The policy was revised to be consistent with Medicare's national coverage policy for Off-Label U... Read More..


Recently Released MLN Matters Articles

Recently Released MLN Matters Articles of Particular Interest (201008-15)   MLN Matters Article #MM7014 - Home Health Agencies (HHAs) Providing Durable Medical Equipment (DME) in Competitive Bidding Areas   The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM7014 to alert Home Health Agencies (HHAs) th... Read More..


Proper Use of Modifiers LT and RT

Proper Use of Modifiers LT and RT   National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) would like to clarify when and how to use modifiers LT and RT.    LT     Left Side (Used to identify procedures performed on the left side of the body) RT     Right Side (Used to identify procedures pe... Read More..


ICD-10 Implementation in a 5010 Environment Call

SAVE THE DATE!  ICD-10 Implementation in a 5010 Environment Follow-Up National Provider Call (201008-02)   The Centers for Medicare & Medicaid Services (CMS) will host a follow-up national provider conference call on "ICD-10 Implementation in a 5010 Environment". This toll-free teleconference will focus on ICD-10 implementation issues, including proposals to part... Read More..


Jurisdiction B News: Update to Banking Transition Date

Update to Banking Transition Date (201007-61)   The CMS awarded new banking contracts to U.S. Bank and JP Morgan Chase.  Medicare providers do not have to take any action.  However, providers should be aware that the Medicare payments may be made by a different bank than in the past because of these new banking contractors.    Due to issues identified in testing, providers t... Read More..


Oral Anticancer Drugs – Covered Diagnoses

Oral Anticancer Drugs – Covered Diagnoses In March 2010, a revised Oral Anticancer Drugs Policy Article was published with an effective date of June 1, 2010.  That policy revision defined the ICD-9 diagnosis codes for which each drug would be covered.  The DME MAC medical directors have received a number of requests for reconsideration of the policy to add additional diagnosis codes.  A r... Read More..


Meeting on ACA Requirements for ICD-10 Crosswalk Revisions

Online Registration Opens August 13 for the September 15 Meeting on ACA Requirements for ICD-10 Crosswalk Revisions (201007-57) CMS Headquarters, 7500 Security Blvd, Baltimore, MD   Mark your calendars for Friday, August 13, when online registration opens for the September 15-16 ICD-9-CM Coordination and Maintenance (C&M) Committee meeting.  The C&M meeting is a p... Read More..


Jurisdiction B News: Refunding Medicare Overpayments

Refunding Medicare Overpayments   When the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) determines that a supplier has been overpaid, an initial demand letter (overpayment letter) is issued to the supplier which identifies the services that triggered the overpayment process.  The demand letter contains a document control number (DCN) which must... Read More..


Jurisdiction B News: Update - Expansion of Editing for Ordering/Referring

Update: Expansion of Editing for Ordering/Referring Physicians and Non Physician Practitioners on DMEPOS Claims   The Centers for Medicare and Medicare Services (CMS) Reviews PECOS Enrollment Process - Important Dates The Centers for Medicare & Medicaid Services issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act (ACA) that perm... Read More..


Jurisdiction B News: Clarification on DMEPOS Accreditation Requirements

Clarification on DMEPOS Accreditation Requirements   Accreditation is the process by which an organization is authorized and credentialed. The Centers for Medicare & Medicaid Services (CMS) requires Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) Medicare suppliers to attain accreditation to ensure industry standards are met and to maintain high levels of excelle... Read More..


Jurisdiction B News: Notice of New Interest Rates for Medicare

Notice of New Interest Rates for Medicare Overpayments and Underpayments The interest rates on overpayments and underpayments is determined in accordance with regulations promulgated by the Secretary of the Treasury and is the higher of the private consumer rate or the current value of funds rate prevailing on the date of final determination. Interest accrues from the date of the i... Read More..


Jurisdiction B News: New DMEPOS Competitive Bidding Program Fact Sheet

CMS Announces Release Of New DMEPOS Competitive Bidding Program Fact Sheet For Referral Agents (201007-29)   The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program is scheduled to begin in nine competitive bidding areas (CBAs) on January 1, 2011.  The competitive bidding program will offer beneficiaries in the designated CBAs ... Read More..


Jurisdiction B News: Medicare Enrollment Guidance for Physicians

Medicare Enrollment Guidance for Physicians that Infrequently Receive Reimbursement from the Medicare Program (201007-25)   Traditionally, most physicians have enrolled in the Medicare program to furnish covered services to Medicare beneficiaries. However, with the implementation of Section 6405 of the Affordable Care Act, some physicians will need to enroll in the Medicare program fo... Read More..


Jurisdiction B News: Recovery Audit Contractor Section Added to NGSMedicare.com

Recovery Audit Contractor Section Added to NGSMedicare.com   National Government Services is pleased to announce the addition of a new Recovery Audit Contractor section to the NGSMedicare.com Web site. Provider and supplier interest in the Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractor (RAC) Program helped drive our decision to add the new RAC section. Your opi... Read More..


Electronic Health Record (EHR) Incentive Program “Meaningful Use” Final Rule (CMS-0033-F)

Today, CMS and ONC jointly announce their final rules for both electronic health record standards for certification and the Medicare and Medicaid EHR incentive programs, including the definition of meaningful use. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medic... Read More..


2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 3:00 p.m. – 4:30 p.m., EDT, on Tuesday, July 20, 2010. The PQRI is voluntary quality reporting program that provi... Read More..


New Interest Rates: Prompt Payment Interest Rate

New Interest Rates: Prompt Payment Interest Rate - The web page of the U.S. Treasury Department has been updated to reflect that effective July 1, 2010, the new prompt payment interest rate is 3.125%. The new rate is effective for scheduled Medicare payment dates of July 1 through December 31, 2010. The rate is applicable to clean electronic and paper claims that have not been paid by the 30t... Read More..


Jurisdiction B News: CMS TO REVIEW PECOS ENROLLMENT PROCESS

CMS TO REVIEW PECOS ENROLLMENT PROCESS (201006-57) Medicare Working with Ordering and Referring Providers and Suppliers to Streamline Enrollment Process   The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) to ensure that Medicare beneficiaries con... Read More..


Jurisdiction B News: SE1024 Recovery Audit Contractor Demonstration High-Risk

JUST RELEASED: MLN Matters Article #SE1024 - Recovery Audit Contractor (RAC) Demonstration High-Risk Vulnerabilities – No Documentation or Insufficient Documentation Submitted (201007-19)   The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1024 as the first in a series of articles concerning RAC high-dollar improper payme... Read More..


Jurisdiction B News: Information Regarding DMEPOS Accreditation for Pharmacies

New Information Regarding DMEPOS Accreditation for Pharmacies (201007-10)   The Centers for Medicare & Medicaid Services (CMS) announces the availability of a new fact sheet that discusses changes The Patient Protection and Affordable Care Act (PPACA) made to the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008.  The changes extend the deadline for pharmacies to su... Read More..


Jurisdiction B News: Medicare Payment for Grandfathering Provisions

Medicare Payment for Grandfathering Provisions (201006-54)   Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program (DMEPOS CBP) Medicare Payment for Grandfathering Provisions for Notice of Proposed Rulemaking (1503-P) BACKGROUND   Under current regulations at 42 CFR §414.408(i)(2), when a beneficiary switches to a cont... Read More..


CMS TO REVIEW PECOS ENROLLMENT PROCESS

Medicare Working with Ordering and Referring Providers and Suppliers to Streamline Enrollment Process The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need. PECOS is ... Read More..


Jurisdiction B News: Proposed DMEPOS Regulatory Updates

Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Provisions in 2011 Physician Fee Schedule's Notice of Proposed Rulemaking (201006-56)   Proposed DMEPOS Regulatory Updates   The Centers for Medicare & Medicaid Services (CMS) has announced certain proposed regulatory provisions for Medicare durable medical equipment, prosthetics, orthotics ... Read More..


Jurisdiction B News: Power-Driven Wheelchair Fact Sheet

Power-Driven Wheelchair Fact Sheet (201006-52)   Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program (DMEPOS CBP) ACA Section 3136 Power-Driven Wheelchairs   BACKGROUND   ACA Section 3136 Power-Driven Wheelchairs   We are proposing to amend the regulations to adjust payment for power-driven whee... Read More..


Jurisdiction B News: Billing Clarification: KX & GA Modifier on Same Claim Line

Billing Clarification: KX AND GA Modifier on Same Claim Line   National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC), has received numerous questions related to the use of the KX and GA modifiers on the same claim line.   Last fall the DME MACs began updating the Local Coverage Determinations (LCD)... Read More..


Jurisdiction B News: Appeals Process for Termination of Competitive Bidding Contract

Appeals Process for Termination of Competitive Bidding Contract (201006-53)   Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program (DMEPOS CBP) Appeals Process for Termination of Competitive Bidding Contract   Provisions for Notice of Proposed Rulemaking (1503-P) BACKGROUND We are proposing to add a new §414.423 t... Read More..


Jurisdiction B News: New Computer Based Training Course Now Available

New Computer Based Training (CBT) Course Now Available   The Jurisdiction B DME MAC strives to deliver detailed information through several resources including the Medicare University.  Now available on Medicare University is a new computer based training course. This computer based training course is an interactive online tutorial, which has been developed to help assist i... Read More..


Jurisdiction B News: Revised Oxygen & Oxygen Equipment Payment & Billing

Revised 6/25/10   Reminder: Oxygen and Oxygen Equipment Payment and Billing Guidelines   National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) would like to remind suppliers about the regulations which permit the supplier to retain ownership of oxygen equipment after receiving payment for furnishing stati... Read More..


STATEMENT ON THE ONE YEAR ANNIVERSARY OF OBAMA “YEAR OF COMMUNITY LIVING” INITIATIVE

Eleventh Anniversary of Olmstead Supreme Court Ruling Also Observed In honor of today’s one year anniversary of the Obama Administration’s “Year of Community Living,” Health and Human Services Secretary Kathleen Sebelius announced new funds for states to build innovative systems to link persons with disabilities to affordable housing in their home communities. This new $3.2 million, thre... Read More..


The President Signs the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010

The President Signs the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010   CMS Learn Resource 201006-42   The President Signs the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010—2.2 Percent Medicare Physician Fee Schedule Update for June 1, 2010 Through November 30, 2010.   On June... Read More..


Jurisdiction B News: Oxygen & Oxygen Equipment Payment and Billing Guidelines

Reminder: Oxygen and Oxygen Equipment Payment and Billing Guidelines National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) would like to remind suppliers of their obligation to transfer ownership for stationary and/or portable oxygen equipment after 36 continuous months of rental. In July 2006 the Centers fo... Read More..


One Year Anniversary of Obama "Year of Community Living"

STATEMENT ON THE ONE YEAR ANNIVERSARY OF OBAMA “YEAR OF COMMUNITY LIVING” INITIATIVE (201006-39)  Eleventh Anniversary of Olmstead Supreme Court Ruling Also Observed  In honor of today’s one year anniversary of the Obama Administration’s “Year of Community Living,” Health and Human Services Secretary Kathleen Sebelius announced new funds for states to build innovative systems to li... Read More..


Jurisdiction B News: External Provider User ID Access Recertification Underway!

External Provider User ID Access Recertification Underway!   Per Medicare security requirements, National Government Services will be conducting the annual recertification of all current online system users which includes:   Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) for Medicare Part A providers Professional Provider... Read More..


Jurisdiction B News: July 2010 Average Sales Price Files Are Now Available

July 2010 Average Sales Price (ASP) Files Are Now Available (201006-28)   The Centers for Medicare and Medicaid Services (CMS) has posted the July 2010 ASP and NOC pricing files and crosswalks.  The ASP pricing files for April 2010, January 2010, October 2009, and July 2009 have also been updated.  All are available for download at: http://www.cms.hhs.gov/McrPartBDrugAvgSal... Read More..


Jurisdiction B News: Medicare DMEPOS 101 Webinars Registration Now Available

Medicare DMEPOS 101 Webinars: Registration Now Available   The Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Provider Outreach and Education (POE) Department will be hosting two quarterly Medicare 101 webinars: Intake Process and Billing Process. These webinars are beneficial for new staff or those individuals wishing to refresh their bas... Read More..


Jurisdiction B News: Open Q&A Teleconference Registraton Now Available

Jurisdiction B DME MAC Ask-the-Contractor Teleconference Open Question and Answer Session   National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) will host an Ask-the-Contractor Teleconference (ACT) on Monday, June 28, 2010.  The teleconference will begin at 2:00 pm eastern time and conclude at 3:00 pm ET. ... Read More..


Jurisdiction B News: Maximum Period for Submission of Medicare Claims Reduced

Reminder - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months (201006-17)   REMINDER :  The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 -- Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 – Maximum Period for Submission of Medicare Claims Reduced to N... Read More..


HCPCS Code E1390 – Service-Specific Pre-pay Review

NOTE: This article and the accompanying ListServ message originally indicated that HCPCS code E1390 applied to powered pressure-reducing air mattresses. This has been corrected and CIGNA Government Services apologizes for any confusion this may have caused. CIGNA Government Services, the Jurisdiction C DME MAC, will be implementing a service-specific Medical Review edit for Healthcare Co... Read More..


Jurisdiction B News: National Men’s Health Week and Father’s Day

June 14-20 th is National Men’s Health Week and June 20 th is Father’s Day (201006-18)   In the spirit of National Men’s Health Week and Father’s Day, the Centers for Medicare & Medicaid Services (CMS) asks providers to help keep men with Medicare healthy by encouraging them to take advantage of Medicare-covered preventive services   What You Can Do: ... Read More..


FAQs Concerning Physician's Signatures

Where does it say documentation must be signed? Guidelines surrounding signature requirements can be found in the Medicare Internet Only Manual (IOM) Publication 100-2, Ch3, sect 3.4.1.1(b) Please note that all services ordered or rendered to Medicare beneficiaries must have a signature. While orders for diagnostic tests do not have to be signed, either the order ... Read More..


Jurisdiction B News: Fraud Prevention Education Campaign Launch

Fraud Prevention Education Campaign Launch (201006-11)   HHS, CMS and the Administration on Aging Launch Fraud Prevention Education Campaign to Ensure Medicare Beneficiaries are Protected from Scams Kicks off with a $1 million national & ethnic radio buy targeted around the $250 one time tax-free donut hole rebate check included in the Affordable Care Act   As eligible se... Read More..


Jurisdiction B News: Listening Session for Office of the Inspector General

Outreach Listening Session for Office of the Inspector General (OIG) Reports Part B/Hospice and Part A/Coding/PEPPER (201006-09)   The Centers for Medicare & Medicaid Services (CMS) would like to announce a series of three national outreach listening sessions that will focus on several OIG released reports. The purpose of the calls is to educate providers and suppliers on sp... Read More..


Jurisdiction B News: Preparing for a Transition to a MAC

MLN Matters Number: SE1017 Related Changed Request (CR) #: NA Related CR Release Date: NA Effective Date: NA Related CR Transmittal #: NA Implementation Date: NA   Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC) or from one Durable Medical Equipment (DME) MAC to another DME MAC ... Read More..


Jurisdiction B News: Medicare Provides Assistance to Low-Income Beneficiaries

More Medicare beneficiaries will qualify for “Extra Help” with their prescription drug costs, and be eligible to pay no more than $2.50 for generic drugs and $6.30 for each brand name drug thanks to changes to Medicare’s Low-Income Subsidy Program (also known as LIS or “Extra Help”) that take effect this year. These changes make it easier than ever for people on Medicare with limited incomes to s... Read More..


June 6th is National Cancer Survivors Day

June 6th is National Cancer Survivors Day (201006-03)   In the spirit of National Cancer Survivors Day, the Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage for a variety of preventive services, including certain cancer screenings.  By encouraging your patients with Medicare to take advantage of covered screenings,... Read More..


Jurisdiction B News: Medicare DMEPOS 101 Webinars Registration Now Available

Medicare DMEPOS 101 Webinars: Registration Now Available   The Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Provider Outreach and Education (POE) Department will be hosting two quarterly Medicare 101 webinars: Intake Process and Billing Process. These webinars are beneficial for new staff or those individuals wishing to refresh their basic DMEP... Read More..


Jurisdiction B News: ICD-10 Implementation in a 5010 Environment Call

ICD-10 Implementation in a 5010 Environment National Provider Conference Call (201005-41)   The Centers for Medicare & Medicaid Services (CMS) will host a national provider conference call on " ICD-10 Implementation in a 5010 Environment".   When: Tuesday, June 15, 2010    Time:  12:00 p.m. – 2:00 p.m. ET   Target Aud... Read More..


Jurisdiction B News: Claim Submission When More Than Four Modifiers are Required

Billing Reminder: Claim Submission When More Than Four Modifiers are Required When claims are submitted without all of the required modifiers, the rejection ANSI-16 (Claim lacks information need for adjudication) is given. This is a common error for claims received by the Jurisdiction B DME MAC.  The CEDI front-end will not validate the HCPCS modifier combination in all cases which then re... Read More..


Jurisdiction B News: Implementation of the New HIPAA Formats

Implementation of the new Health Insurance Portability and Accountability Act Formats for all Durable Medical Equipment Medicare Administrative Contractor Electronic Trading Partners   Are you prepared for the conversion to the new Health Insurance Portability and Accountability Act (HIPAA) formats? Will your software be ready in time? The Centers for Medicare & Medicaid Servic... Read More..


Sixth National Education Call on Medicare FFS

Reminder: Sixth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0 Transactions (201005-27)   Medicare FFS 5010 Program: Taking EDI to the Next Level   May 26, 2010 2:00pm - 3:30pm EST   The Centers for Medicare & Medicaid Services (CMS) will host its sixth national education call regarding Medicare FFS’s imple... Read More..


Jurisdiction B News: Proper Use of the ABN & Related Modifier GA

Proper Use of the Advance Beneficiary Notice of Noncoverage and Related Modifier GA   The Advance Beneficiary Notice of Noncoverage (ABN) is required in certain situations to inform a Medicare fee-for-service beneficiary of an expected denial and protect the supplier from financial liability.  The ABN applies to both assigned and non-assigned claims for DMEPOS services disallowed for th... Read More..


Jurisdiction B News: Updated Banking Transition

Updated Banking Transition (201005-31)   The CMS recently awarded new banking contracts to U.S. Bank and JP Morgan Chase.  Medicare providers do not have to take any action.  However, providers should be aware that the Medicare payments may be made by a different bank than in the past because of these new banking contractors.   The following Medicare claims processing contract... Read More..


Jurisdiction B News: Building a Nationwide Health Information Network

There Is No ‘One-Size-Fits-All’ in Building a Nationwide Health Information Network (201005-35)   A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology  May 14, 2010 Private and secure health information exchange enables information to follow the patient when and where it is needed for better care.  The Federal government is working to e... Read More..


Jurisdiction B News: CEDI Ordering/Referring Provider Edits

CEDI Ordering/Referring Provider Edits   The Centers for Medicare & Medicaid Services (CMS) has updated the “OrderingReferringReport” file containing the National Provider Identifier (NPI) and the name (last name, first name) of all physicians and nonphysician practitioners who are of a type/specialty that is eligible to order and refer in the Medicare Program and who have current enrol... Read More..


Jurisdiction B News: Patient Responsibility Denials

National Government Services, the Jurisdiction B DME MAC would like to remind Durable Medical Equipment suppliers that Group codes which are indicated on the electronic remittance advice (ERA) or standard paper remittance advice establish financial liability for the amount of the adjustment or to identify a post-initial-adjudication adjustment.   PR - Patient responsibility -- This sig... Read More..


Jurisdiction B News: New Glucose Monitor Supplies Physician Letter

To assist suppliers in obtaining medical necessity documentation from the physicians, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) Medical Directors have developed a variety of letters to aid in obtaining these records.  These letters provide an explanation of the physician’s obligation by law to provide the requested medical records to the supplier. Since Glucose ... Read More..


PROVENGE® (sipuleucel-T)

PROVENGE® (sipuleucel-T) is approved by the FDA as an autologous cellular immunotherapy for the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer. Use miscellaneous code J3590 or J9999 to file for PROVENGE. The name of the drug/biologic and the dosage administered (250ml bag) must be in block 19 for paper claims or the elect... Read More..


Jurisdiction B News: Group 3 Support Surfaces – Coverage Criteria Reminder

  Group 3 Support Surfaces – Coverage Criteria Reminder - May 2010 (A49958)   Recently is has come to the attention of the DME MACs that there is confusion regarding the coverage of air-fluidized bed technology (Group 3 support surfaces) for patients who have undergone surgical flap or graft procedures. Medicare does not cover air-fluidized beds in the home setting for patients wit... Read More..


Jurisdiction B News: Implementation of Patient Protection & Affordable Care Act

Implementation of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010 (201005-24)   On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act.  One week later, on March 30, the President also signed into law the Health Care and Education Reconciliation Act of 2010.  These two new laws have a sign... Read More..


Jurisdiction B News: CMS 2010 ICD-10/5010 National Provider Conference Call

CMS 2010 ICD-10/5010 National Provider Conference Call (201005-13)   Hold the Date For The CMS 2010 ICD-10/5010 National Provider Conference Call The Centers for Medicare & Medicaid Services (CMS) will host a national provider conference call on “ICD-10 Implementation in a 5010 Environment”   When : Tuesday, June 15, 2010   Time : 12:00 p.m. – 2:... Read More..


Jurisdiction B News: HCPCS Public Meeting Agenda for Durable Medical Equipment

Healthcare Common Procedural Coding System (HCPCS) Public Meeting Agenda for Durable Medical Equipment (201005-23)   June 8, 2010 HCPCS Public Meeting Agenda for Durable Medical Equipment   The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of the June 8, 2010 HCPCS Public Meeting Agenda for Durable Medical Equipment. This document and th... Read More..


May 9-15 is National Women’s Health Week!

In the spirit of  National Women’s Health week, the Centers for Medicare & Medicaid Services asks providers to help keep women with Medicare healthy by encouraging them to take advantage of Medicare-covered Preventive Services. Medicare covers a wide range of preventive services that can help women with Medicare live longer, healthier lives.  The preventive services Medicare covers... Read More..


Jurisdiction B News: Coding Guidelines for Therapeutic Shoes for Diabetes

This article is being published to reemphasize a policy that has been in place since the initiation of Coding Verification Reviews of Therapeutic Shoes and Inserts.   A5500 and A5501 include two components to the codes.  The first component is the fitting and follow-up associated with dispensing the shoes.  The second is the composition and characteristic components of the shoe. ... Read More..


Jurisdiction B News: Federal Funds for Electronic Health Record Incentives

Four States (MO, NM, OR, WA) and Puerto Rico to Receive Federal Matching Funds for Electronic Health Record Incentives Program (201005-08)   In another key step to further states’ role in developing a robust U.S. health information technology (HIT) infrastructure, the Centers for Medicare & Medicaid Services (CMS) announced additional federal matching funds for certain state planning ac... Read More..


Jurisdiction B News: Artificial Limbs, Braces, & Custom Made Items & Expenses

National Government Services, the Jurisdiction B Durable Medical Equipment Administrative Contractor (DME MAC) has received several questions regarding whether or not the expenses for custom made items that have been canceled or not picked up by the patient can be billed to Medicare. The Internet Only Manual (IOM) 100-2, Chapter 15, Section 20.3 states the following:   If a custom made-... Read More..


Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404

Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months This issue impacts all physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, durable medical equipment Medicare administrative contractors (DME MACs), fiscal intermediaries (FIs), Part A/B Medicare administrative contractors (A/B MACs), and/or regional home health intermediar... Read More..


Jurisdiction B News: When to use the Jurisdiction B DME MAC Online Inquiry Form

National Government Services recently created a Customer Care Online Inquiry form that can be used by providers/suppliers to submit questions and requests regarding basic Medicare regulations, coverage, and claims filing issues to the General Inquiries team. Prior to the creation of this online inquiry form, suppliers were required to submit the request in writing via mail to National Governme... Read More..


Jurisdiction B News: Think Green and Go Paperless!

Think Green and Go Paperless! Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) suppliers should be sending electronic claims and signed up for both the electronic remittance advice (ERA) and electronic funds transfer (EFT) to begin realizing the tremendous benefits associated with these electronic transactions. Learn more about these electronic... Read More..


Recent Trends in Nebulizer and RAD Claims

CIGNA Government Services is receiving a large volume of requests to add, change, or remove diagnosis codes for nebulizers and respiratory assist devices, as well as their respective supplies. Initial denials for these claims can be avoided by adhering to the requirements for coverage of these items, which can be found in the appropriate Local Coverage Determination (LCD) . LCDs contain informat... Read More..


Jurisdiction B News: Special Edition MLN Matters Article #SE1008

Special Edition MLN Matters Article #SE1008 - Medicare Coverage of Blood Glucose Monitors and Testing Supplies (201004-35)   The Centers for Medicare & Medicaid Services (CMS) has released a Special Edition MLN Matters article to advise providers of what glucose self-testing equipment and supplies are covered for Medicare beneficiaries and what documentation is required for the benefi... Read More..


Jurisdiction B News: Reminder: Fifth National Education Call on HIPAA 5010

Reminder: Fifth National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010 (201004-37)   5010:  Taking EDI to the Next Level    Fifth National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010 – April 28, 2010 Registration will close at 2:00 p.m. ET on April 27, 2010, or when available space has been filled.   The Centers f... Read More..


Jurisdiction B News: Join the Medicare Contractors at the Medtrade Exposition!

The Medtrade Spring Conference and Expo is the leading event in the home medical equipment industry. It offers nearly 400 exhibitors showcasing the latest Home Medical Equipment (HME) products and services in the market. Attend conferences lead by industry professionals all guided toward helping you make smart decisions about the issues you are facing in today’s business environment.  Also, this ... Read More..


National Government Services is Igniting Medicare Education in 2010!

In the months of May and June, National Government Services, your Jurisdiction 13 Part A and Part B Medicare Administrative Contractor, will be hosting two-day conferences in five locations throughout Connecticut and New York . We are very excited about offering live sessions and want to make sure we get the word out as soon as possible! There will be over 50 courses available at... Read More..


Announcing National Government Services Medicare Part B New Provider Basic 101 Seminars 2010

The National Government Services, Inc., Medicare Part B Provider Outreach and Education department is offering new Provider Basic 101 seminars throughout the states of Indiana and Kentucky in May-July 2010. This is a great learning experience for individuals who are new to the Medicare program or seasoned staff that may want a refresher course. We encourage providers to register early as seating ... Read More..


The Continuing Extension Act of 2010 Extends Zero Percent Medicare Physician Fee Schedule (MPFS) Update

On April 15, 2010, President Obama signed into law the "Continuing Extension Act of 2010." This law extends through May 31, 2010, the zero percent update to the MPFS that was in effect for claims with dates of service January 1, 2010 through March 31, 2010. The law is retroactive to April 1, 2010. Consequently, effective immediately, claims with dates of service April 1 and later, which were bein... Read More..


Jurisdiction B News: New Interest Rate for Medicare Overpayments & Underpayments

The interest rates on overpayments and underpayments is determined in accordance with regulations promulgated by the Secretary of the Treasury and is the higher of the private consumer rate or the current value of funds rate prevailing on the date of final determination. Interest accrues from the date of the initial request for refund and is assessed for each 30-day period, or portion thereof, th... Read More..


Announcing National Government Services Medicare Part B New Provider Basic 101 Seminars 2010

The National Government Services, Inc., Medicare Part B Provider Outreach and Education department is offering new Provider Basic 101 seminars throughout the states of Indiana and Kentucky in May-July 2010. This is a great learning experience for individuals who are new to the Medicare program or seasoned staff that may want a refresher course. We encourage providers to register early as seating ... Read More..


Jurisdiction B News: How to Successfully Bill for an Oxygen Denial

How to Successfully Bill for an Oxygen Denial National Government Services, the Jurisdiction B Durable Medical Equipment Administrative Contractor (DME MAC) has received several questions regarding how to bill in order to receive an oxygen denial. In situations where suppliers are aware that the beneficiary does not meet the medical necessity coverage criteria as outlined in the Local C... Read More..


April is National Cancer Control Month (201004-16)

The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage for certain cancer screenings. These screenings can help detect cancer in its earliest stages when outcomes are most favorable.   Medicare Covered Cancer Screenings   Screening mammographies, Screening pap tests, Screening pelvic examination,... Read More..


Jurisdiction B News: Section 2902 the Patient Protection & Affordable Care ACT

This special edition article was initially issued by the Centers for Medicare & Medicaid Services (CMS) to notify affected IHS physicians, IHS providers, and IHS suppliers that, per the provisions of section 630 of the MMA, certain Part B services were no longer covered for Medicare payment when the provisions sunset as of December 31, 2009. However, on March 23, 2010, President Obama signed i... Read More..


Medicare Appeals – The Importance of Getting it to the Right Place at the Right Time!

Over the past year, the Qualified Independent Contractor (QIC) Part B North (the processor of second – level appeals or reconsiderations ) has consistently made a high rate of dismissal decisions. Based on data analysis, the driving factor in this high rate is that appellants, primarily providers, request reconsideration when a redetermination (first level appeal performed by CIGNA Government ... Read More..


Detailed Written Orders

Medicare requires an order for every item (except repairs) of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Detailed written orders are used to confirm what was ordered by the treating physician following the supplier’s receipt of a verbal or written dispensing order. Detailed written orders must include separately billable options, accessories or supplies related ... Read More..


Jurisdiction B News: Oral Appliances for Obstructive Sleep Apnea

Oral Appliances for Obstructive Sleep Apnea (OAOSA) – Billing Information – April 2010 (A49580)   Many providers of OAOSA items are not traditional DME suppliers, coming instead from the medical and dental communities. Reimbursement policy for DME often differs from the billing for E&M services or medical and surgical procedures. This article will review some key elements about billing ... Read More..


Jurisdiction B News: 2010 Medicare Contractor Provider Satisfaction Survey

2010 Medicare Contractor Provider Satisfaction Survey (201004-13)   Attention: All Physicians, Hospitals, Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs) Selected to Participate in the 2010 Medicare Contractor Provider Satisfaction Survey (MCPSS) and Proxy Billing Agents  CMS needs to hear from you. To date, the response rate fo... Read More..


Jurisdiction B News: April 5-11 is Public Health Week & April 7 is World Health

April 5-11 is National Public Health Week and April 7 is World Health Day! (201004-08)   In the spirit of National Public Health Week and World Health day, the Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage for a variety of preventive services.  By encouraging your Medicare patients to take advantage of covered p... Read More..


Jurisdiction B News: HCPCS Public Meeting Agendas

HCPCS Public Meeting Agendas for Drugs, Biologicals and Radiopharmaceuticals (201004-12)   The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of the May 4 & 5, 2010 HCPCS Public Meeting Agendas for Drugs, Biologicals and Radiopharmaceuticals.  These documents and the link for the corresponding public meeting registrations are located on th... Read More..


Jurisdiction B News: Oxygen & Oxygen Equipment Lunch & Learn Materials Available

Oxygen and Oxygen Equipment Lunch and Learn Teleconference Materials Now Posted   National Government Services, the Jurisdiction B DME MAC would like to inform suppliers that the Oxygen and Oxygen Equipment Lunch and Learn Teleconference materials are now available on the National Government Services  Web site ( www.NGSMedicare.com ) under Education and Support – Trainin... Read More..


Jurisdiction B News: CEDI Inactive Trading Partners

Beginning March 31, 2010, CEDI will disable Submitter/Trading Partner IDs that have been inactive for 90 days. Submitters/Trading Partners who do not log in to the CEDI Gateway within 90 days will need to contact the CEDI Help Desk to have their Submitter/Trading Partner ID re-enabled.   CEDI will continue to identify inactive Submitters/Trading Partners who have not logged in to t... Read More..


New National Government Services Medicare Part B PrePass Edits-Effective April 1, 2010

New Medicare Part B PrePass Edits—Effective April 1, 2010   Effective Thursday, April 1, 2010 the following Medicare Part B PrePass edits will be received and set to “REJECT” by National Government Services. This instruction impacts electronic data interchange (EDI) submitters who submit claims in the Health Insurance Portability and Accountability Act (HIPAA)-compliant ANSI X12N... Read More..


Jurisdiction B News: Diabetes Alert Day

Note: Diabetes Alert Day was March 23 rd , review the message below to help increase awareness.    March 23 rd is Diabetes Alert Day (201003-38) ~ Please join with the Centers for Medicare & Medicaid Services (CMS) in promoting increased awareness of the diabetes-related preventive services covered by Medicare.   Medicare Coverage of Diabetes-Related... Read More..


Jurisdiction B News: April 2010 Average Sales Price Files Are Now Available

April 2010 Average Sales Price (ASP) Files Are Now Available (201003-40)   The Centers for Medicare and Medicaid Services (CMS) has posted the April 2010 ASP and NOC pricing files and crosswalks.  The ASP pricing files for January 2010, October 2009, July 2009, and April 2009 have also been updated.  All are available for download at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/... Read More..


Jurisdiction B News: New From The Medicare Learning Network

New From The Medicare Learning Network (201003-43)   The Medicare Learning Network (MLN) Marketing Brochure is now available in print format!   Do you want to be “in the know” when it comes to the Medicare Learning Network?  Would you like to let your colleagues and employees in on a valuable secret that can help them with their Medicare fee-for-service business transactio... Read More..


Jurisdiction B News: Fourth National Medicare FFS Education Call on HIPAA

Rescheduled: Fourth National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010 (201003-26)   The Centers for Medicare & Medicaid Services (CMS) will be hosting its fourth national provider call regarding the implementation of HIPAA Version 5010. There will be a brief presentation given by CMS followed by a Q&A session with CMS subject matter experts. Please note that... Read More..


Jurisdiction B News: New From The Medicare Learning Network

OF SPECIAL NOTE!   The Centers for Medicare & Medicaid Services (CMS) continues to break new ground to enhance our Medicare Fee-For-Service outreach efforts. CMS is now using the following social media outlets to get information out to our audience as fast as possible.   LinkedIn:   Join the CMS group at www.LinkedIn.com/in/CMSGov      YouTube :  Log... Read More..


Medicare Ends Contract with Fox Insurance Company Drug Plan

March 16, 2010 Members Will Be Provided Access to Drugs While Transitioning to New Plans The Centers for Medicare & Medicaid Services (CMS) today terminated its contract with Fox Insurance Company. After an onsite review of the plan and its services, CMS determined that the plan's significant deficiencies – not meeting Medicare's requirements to provide enrollees with prescription... Read More..


Jurisdiction B News: Soliciting Phone Calls to Medicare Beneficiaries

The National Government Services Jurisdiction B Clinical Education department has received many referrals regarding suppliers soliciting beneficiaries via telephone for Medicare covered item(s).  It is very important for suppliers to be aware that they are prohibited under section 1834 (a) (17) (a) of the Social Security Act against unsolicited telephone contacts by suppliers.   S... Read More..


Jurisdiction B News: Five-Star Quality Rating System – March News

1. The Five-Star provider preview reports will be available beginning Monday, March 15, 2010.  Providers can access the report from the Minimum Data Set (MDS) State Welcome pages available at the State servers for submission of Minimum Data Set data. Provider Preview access information: Visit the MDS State Welcome page available on the State servers where you submit MDS ... Read More..


Attention All Express Plus Users: Reminder - Express Plus Transitioning to PC-ACE Pro32

The Common Electronic Data Interchange (CEDI) currently supports both Express Plus and PC-ACE Pro32 for billing durable medical equipment (DME) electronic claims. After careful consideration, CEDI has decided to transition support to one free software; PC-ACE Pro32. As of April 1, 2010, the CEDI Help Desk will no longer support the Express Plus software. CEDI feels this will best meet the needs o... Read More..


Jurisdiction B News: Knee Orthoses Lunch & Learn Registration Information

The Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC), Provider Outreach and Clinical Education Department is offering a free one hour teleconference on the Knee Orthoses local coverage determination. We will not be able to conduct the usual Question and Answer session at the end of this teleconference, so we ask that any questions you may have be sent to the ... Read More..


Jurisdiction B News: Proposed Rule for Establishment of Certification Programs

Proposed Rule for the Establishment of Certification Programs for Health Information Technology (201003-07) A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology March 2, 2010 Today the Secretary of the Department of Health and Human Services (HHS) released a notice of proposed rulemaking (NPRM) outlining the proposed approach for establish... Read More..


Important Training Opportunity from National Government Services: Consultation Code Seminars

Consultation Code Seminars Medicare no longer pays for the CPT consultation codes (ranges 99241-99245 and 99251-99255), as of Jan. 1, 2010. National Government Services is offering four seminars in March to help providers understand the changes in Medicare coding and payment for consultation services. Providers of all specialties should plan on attending one of these sessions.   ... Read More..


Jurisdiction B News: Knee Orthoses Lunch & Learn Registration Now Available

Registration Now Available – Knee Orthoses Lunch and Learn   The Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Provider Outreach and Clinical Education Department offers a variety of free one-hour teleconferences titled “Lunch and Learns” that will provide an overview of a specific DME medical policy.   A “Lunch and Learn” teleconfer... Read More..


Part B Announcement from CIGNA Government Services

New Medicare Learning Network (MLN) Matters Article Regarding "Questions and Answers on Reporting Physician Consultation Services" The MLN Matters Special Edition Article #SE1010 entitled, "Questions and Answers on Reporting Physician Consultation Services," has just been released and is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1010.pdf on the CMS website. ... Read More..


Part B Announcement from CIGNA Government Services

New Medicare Learning Network (MLN) Matters Article Regarding "Questions and Answers on Reporting Physician Consultation Services" The MLN Matters Special Edition Article #SE1010 entitled, "Questions and Answers on Reporting Physician Consultation Services," has just been released and is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1010.pdf on the CMS website. ... Read More..


Jurisdiction B News: March 2010 Jurisdiction B Connections Now Available

  The March 2010 Jurisdiction B DME MAC Connections is now available on the National Government Services Web site. Suppliers can access the Jurisdiction B DME MAC Connections in either a PDF or HTML format.   To view the March 2010 Bulletin click on or copy the following link into your internet browser:  http://www.ngsmedicare.com/content.aspx?CatID=3&DOCID=599 Read More..


Jurisdiction B News: Reminder - Express Plus Transitioning to PC-ACE Pro32

The Common Electronic Data Interchange (CEDI) currently supports both Express Plus and PC-ACE Pro32 for billing durable medical equipment (DME) electronic claims. After careful consideration, CEDI has decided to transition support to one free software; PC-ACE Pro32. As of April 1, 2010, the CEDI Help Desk will no longer support the Express Plus software. CEDI feels this will best meet the needs o... Read More..


Jurisdiction B News: LCD & Policy Article Revisions for February 25, 2010

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. Lower Limb Prostheses LCD Revision Effective Date: 01/01/2010 INDICATIONS AND LIMITATIONS OF COVERAGE: Added:  Functional level... Read More..


Physician Consultation Codes No Longer Valid for Medicare:

In December 2009, the Centers for Medicare & Medicaid Services (CMS) issued CR 6740 instructing that as of January 1, 2010, Current Procedural Terminology (CPT) consultation codes 99241 - 99245 and 99251 - 99255 are no longer valid for Medicare Part B billing. Because this affects Part A billing as well, CMS will be issuing a separate CR to address Part A billing as it relates t... Read More..


Information Regarding the Holding of Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule - MPFS

The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule. As you are aware, the Department of Defense Appropriation... Read More..


Jurisdiction B News: CMS Needs Your Feedback

The Centers for Medicare & Medicaid Services (CMS) is conducting the fifth national administration of the Medicare Contractor Provider Satisfaction Survey (MCPSS) . This survey is designed to collect quantifiable data on providers’ satisfaction with the performance of the Medicare fee-for-service (FFS) contractors that process and pay their Medicare claims. CMS conducts the MCPSS on an annual ba... Read More..


Jurisdiction B News: Physician PECOS Requirement Letter - REVISED

National Government Services, the Jurisdiction B durable medical equipment (DME) Medicare administrative contractor (MAC) has revised the letter that DMEPOS suppliers can print and send to physicians who order DMEPOS items for their patients.   The Centers for Medicare & Medicaid Services (CMS) has announced that they will delay until January 3, 2011 , the implementation of Phase 2... Read More..


Jurisdiction B News: Medicare DMEPOS Billing Workshops Registration Available

Registration is Now Available for the Medicare DMEPOS Billing Workshops! The Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Provider Outreach and Education Department will be conducting Medicare billing workshops in April 2010. These interactive workshops are designed for all suppliers of durable medical equipment prosthetics, orthotics, and supplies ... Read More..


LCD and Policy Article Revisions Summary for February 25, 2010

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. Lower Limb Prosthesis LCD Revision Effective Date: 01/01/2010 INDICATIONS AND LIMITATIONS OF COVERAGE: Added: F... Read More..


New from the Medicare Learning Network

The revised Medicare Appeals Process brochure (January 2010), which provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians and other suppliers who provide services and supplies to Medicare beneficiaries, as well as details on where to obtain more information about this appeals process, is now available in downloadable... Read More..


DME MAC Jurisdiction C Webinars

About our Webinars: Registered participants will receive connection instructions via email prior to the webinar. Please limit registrants to one per supplier. If you have multiple participants in the same location, we encourage you to call in from a meeting room so everyone can participate. Enteral Nutrition Webinar This detailed session will focus on the coverage ... Read More..


Update on Claims Processing for Ordering/Referring Providers

The Centers for Medicare & Medicaid Services (CMS) will delay until January 3, 2011, the implementation of Phase 2 of Change Request (CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring ... Read More..


Jurisdiction B News: Revision of Definition of Compendia as Authoritative Source

  News Flash – The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued on 12/30/2009 that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. CMS and ONC worked closely to de... Read More..


Jurisdiction B News: DMEPOS Billing Workshop Coming Soon!

The Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Provider Outreach and Education Department will be conducting Medicare billing workshops in April 2010. These workshops will be conducted in the seven states within the Jurisdiction B DME MAC geographical area from April 6 through April 22, 2010.                                  ... Read More..


Attention all FQHC Providers: National Government Services Ask the Contractor Teleconference to be Held on February 25, 2010

The National Government Services Provider Outreach and Education department will conduct the Ask the Contractor teleconference on February 25, 2010.  During this session we will provide brief updates for FQHC providers, and answer questions that have been submitted via clinical.education@wellpoint.com . Please submit your questions by February 18, 2010.     FQHC Ask th... Read More..


Scope on Claims Editing - Medicare Part B

It is a requirement that claims submitted to the Medicare Part B carrier, the Medicare administrative contractor (A/B MAC) or the durable medical equipment (DME) MAC that are the result of an order or referral must include the National Provider Identifier (NPI) and the name of the ordering or referring provider. Physician and nonphysician practitioners who are eligible to order/refer must be enro... Read More..


DME MAC Jurisdiction C News

IMPORTANT MESSAGE RE: HIPAA National Provider Conference Call: Due to inclement weather, the National Provider Conference Call on HIPAA 5010 New Error Handling Transactions, which was scheduled to take place Thursday, February 11, 2010 at 2:00 p.m. Eastern Time, has been cancelled. We will keep you informed as to when the call is rescheduled. Agenda Now Available for Program Advi... Read More..


DME MAC Jurisdiction C Frequently Asked Questions (FAQs)

CMS FAQs CMS FAQs Current FAQs Claim Submission FAQs Complex Rehab Repair FAQs General FAQs - Updated 10.05.09... Read More..


Male External Catheter - A4326 - Coding and Utilization Guidelines

October 8, 2009 Code A4326 describes a special type of male exdwelling 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 AlphaD... Read More..


LCD and Policy Article Revisions Summary for October 2009

October 8, 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.   Ankle Foot/Knee Ankle Foot Orthosis LCD Revision Effective Date: 12/01/2009 HCPCS CODES AND MODIFIERS: ... Read More..


2009 Fall Medtrade Conference

October 6, 2009 Come join the Jurisdiction C Provider Outreach and Education Team at Medtrade! The 2009 Fall Medtrade Conference and Exposition is right around the corner! This year's Fall Medtrade will be held October 13-15, 2009 at the Georgia World Congress Center in Atlanta, Georgia. Your Jurisdiction C Provider Outreach and Education Team will be waiting to meet you at the M... Read More..


Common Electronic Data Interchange (CEDI) Front-end Editing for Ordering/Referring Providers

October 6, 2009 Sent on behalf of the CEDI: In compliance with the Centers for Medicare and Medicaid Services (CMS) Change Request, CR6421, and as supplement to the information provided within the MLN Matters article - Expansion of the Current Scope of Editing for Ordering/Referring Providers, MM6421, previously communicated, the following are new edits that will appear on the CEDI Ge... Read More..


Jurisdiction B News: Billing Reminder - Replacement Oxygen Equipment

Billing Reminder - Replacement Oxygen Equipment RA Modifier   National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has identified an erroneous trend in billing for replacement oxygen equipment. Claims for replacement oxygen equipment are being submitted with the RA modifier appended to the initial claim and all subseq... Read More..


Jurisdiction B News: Join the Medicare Contractors at the Medtrade Exposition!

Join the Medicare Contractors at the Medtrade Exposition!   The Medtrade Spring Conference and Expo is the leading event in the home medical equipment industry.  It offers nearly 400 exhibitors showcasing the latest Home Medical Equipment (HME) products and services in the market.  Attend conferences lead by industry professionals all guided toward helping you make smart decisions abo... Read More..


Jurisdiction B News: Activation of New COBA Trading Partner Dispute Error Code

Activation of New Coordination of Benefits Agreement (COBA) Trading Partner Dispute Error Code Within the National Crossover Process.   MLN Matters Number: MM6640 Related Changed Request (CR) #: 6640 Related CR Release Date: September 25, 2009 Effective Date:  October 26, 2009 Related CR Transmittal #: R562OTN Implementation Date: October 26,2009   ... Read More..


October 2009 Issue of the Medicare Monthly Review

The October 2009 issue of the Medicare Monthly Review has been posted on the National Government Services Web site. Please note that you will have to accept the CPT Point and Click Agreement in order to access this information.  Click on www.NGSMedicare.com , select your Business Type and your Region and select "Go". On the Provider Specific Portal Home Page under Quick Links, select Medicare Mo... Read More..


MSP Claims Submitted via FISS/DDE

Important Notice to Providers That Submit Medicare Secondary Payer Claims via Fiscal Intermediary Standard System Direct Data Entry   As of October 5, 2009, National Government Services can no longer accept Medicare Secondary Payer (MSP) claims (including conditional claims) that are submitted via Fiscal Intermediary ... Read More..


DIABCO Introduces ME-First

DIABCO Introduces ME-First TM Get 3 Eligibility Requests For Free! Introducing a new DIABCO software product ME-First™, a real time eligibility system for Medicare. You push the button and get an immediate response. ME-First™ is compatible with all windows based software systems. With this extraordinary software program you’ll immediately know if your client/patient is eligi... Read More..


DIABCO Introduces KeyScan

Looks The Same And Does All Your SCANNING Including PLASTIC We are pleased to introduce KeyScan, a key board which includes the smallest scanner you can imagine. The handiest scanner ever invented. It not only scans paper documents but also plastic as well, such as drivers licenses and insurance cards. Now, when you scan your documents you can easily attach them to your billing software pa... Read More..


DIABCO Introduces VoiceGuide-IVR

7,000 interactive calls to patients got 6,300 positive responses to order products. Imagine the increase of your business if you are doing this as well! VoiceGuide-IVR , an interactive voice response system, is the product that can do this for you. It is absolutely easy to use and works for you right away. You just record your message and send it out. You can offer special discounts, prom... Read More..


Denials Management

Of course, the best denial management is prevention, but everybody gets them.  The DIABCO Denials Management system gives AR-Express users a very visual tool to see denial reasons for any given date range.  It displays counts, percentages, dollar amounts, and the denial descriptions, and it allows grouping by procedure, item or patient.  Individual denial status codes can be selected, giving u... Read More..


Integrated Point of Sale Software

The baby boomers are coming and in the next ten years the number of people with disabilities will explode from 10 to 70 million. Going for the cash is a must! But how to coordinate this rapidly increasing sales opportunities and additional workload? Find out what a smart - it does it all - cash register can do for you. Check out our POS-Success cash register and learn to use it to collect cust... Read More..


The Power to Convert Paper to Profit

We proudly introduce our new partnership with UCoA – Unicomp Corporation of America. UCoA is a company located in Coral Springs, FL and has been in business since 1979. They are dedicated to providing cutting edge software solutions for healthcare providers. With over 20,000 clients using their products on a daily basis, they have one of the largest installed user bases in the industry. UCoA p... Read More..