LCD coverage policy updates
Added: Monday, February 20, 2012
February 20, 2012
Why did this happen?
Due to the high CERT denials for multiple types of DME items the four Medical Directors decided that something had to be done to reduce these errors. Many of the errors were not medical necessity errors but processing errors on suppliers’ part.
The DME supplier is responsible for all areas of processing information that basically includes the online PIM (program integrity manual) as well as policy articles/LCDs/and DME MAC supplier manuals.
Many of the errors found were related to items that can be easily found in these resource...
read more...
Home Health Care for an ACO World
Added: Friday, February 17, 2012
U. S. Rehab Member Home Health Depot, Inc., whose headquarters are in Indianapolis, is embracing the future by positioning itself to help hospitals with the establishment of Accountable Care Organizations.
Mandated by the Patient Protection and Affordable Care Act, ACOs focus on ensuring that patients have “the best possible chance for a positive medical outcome,” says David Hartley, CEO of Home Health Depot.
The company was featured in MDNews e-newsletter. Read “
Home Health Care for an ACO World” here.
...
read more...
Adding license information to your NSC file
Added: Thursday, February 16, 2012
Quick tip from Peggy:
I have received many questions relating to adding a license to your NSC data base and here is the answer from Erika Williams, Ombudsman, NSC
The supplier can send the license to the NSC with a signed cover letter by the authorized or delegated official. The full 855s is not necessary. Now if they are adding a new state where they will be providing services, they will need to complete the appropriate sections of the 855S including the products/services in section 2 and section 4 requesting the state(s) they intend to serve.
read more...
Prior Authorization for PMDS updates
Added: Wednesday, February 15, 2012
What you need to know.
CMS has delayed the Prior Authorization process for power mobility that was to start on January 1, 2012 and was to include a full prepayment review. The full prepayment review has been phased out and the PA will go into effect in all 7 states on the same date.
*********************************************************************************
1. Will start on OR after June 1, 2012
2. States involved will be : CA -- FL-- IL -- MI -- NY -- NC -- and TX
3. The supplier will now be able to submit the prior authorization read more...
CMS Announces Major Changes to Medicare PMD Demonstration Project
Added: Friday, February 3, 2012
CMS has just announced major changes to the PMD Demonstration Project that was
originally scheduled to start on January 1st but was delayed based on
stakeholders’ comments. This Demonstration Project applies to PMD providers in
the states of California, Texas, Florida, Michigan, Illinois, North Carolina,
and New York. Attached is the one page CMS announcement and below are the
announced changes:
1.) CMS has set a new target date of June 1, 2012
or later to begin the demonstration.
2.) CMS has submitted the necessary
PRA (Paper Reduction Act) package for public comment. This will allow providers
and supplier at least 60 days to comment on the...
read more...
Medicare FFS Version 5010 Requirement Changes for Non-Specific Procedure Codes
Added: Tuesday, January 31, 2012
Medicare Fee-for-Service (FFS) has amended the Not-Otherwise-Classified (NOC) code set listing effective Mon Jan 16, 2012. Thus, it has been determined that anesthesia codes that include the phrase “not otherwise specified” in their code descriptors (procedure codes 00100 through 01996) do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements. Anesthesia procedure code 01999, “Unlisted anesthesia procedure(s)” meets the requirements of a non-specified code and continues to require additional information to be supplied in the SV101-7 data element. Read more...
http://www.cgsmedicare.com/jc/pubs/news/2012/0112/cope17889.html
________________________________________
Third...
read more...
DME MAC Jurisdiction C News
Added: Thursday, January 26, 2012
Video Slideshow Presentations from ICD-10 National Provider Calls Available on
CMS YouTube Channel: Is your organization preparing for a smooth transition to
ICD-10 on Tuesday, October 1, 2013? ICD-10 National Provider Calls, hosted by
the CMS Provider Communications Group, can help you prepare for the US
healthcare industry's change from ICD-9 to ICD-10 for diagnosis and inpatient
procedure coding. Read more...
http://www.cgsmedicare.com/jc/pubs/news/2012/0112/cope17817.html
________________________________________
Now Available: New Webcast for
Round 2 and National Mail-Order Bidders: A new educational webcast for the Round
2 and national mail-order competitions of the Medicare Durable Medical
Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding
Program is now available on the Competitive Bidding...
read more...
CMS Clarifies 90-Day Requirement for Credit Reports in Round 2
Added: Wednesday, January 25, 2012
CMS just published the following Q & A on the CBIC web site:
"The Centers for Medicare & Medicaid Services has issued the following clarification to assist suppliers bidding in the Round 2 and national mail-order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. This information will also be posted on the Competitive Bidding Implementation Contractor (CBIC) website. If you have any questions, please contact the CBIC customer service center at 877-577-5331 between 9 a.m. and 9 p.m. Eastern Time during the registration and bidding periods.
Q: The Request for...
read more...
IMPORTANT: VGM Gets Clarification on Credit Report Score for Competitive Bidding
Added: Tuesday, January 24, 2012
Many HMEs have been expressing concern over recent fax receipts from third party consultants and others, which have been picked up by several state associations and distributed to their memberships. The issue is in regard to whether the Round 2 potential bidding companies must have a credit report dated before January 30. Somewhat directly stated - this is NOT true.
Please read Mark Higley's Blog for more information on this issue:
http://www.vgm.com/blog/index.php/2012/01/important-credit-reportscore-clarification/
A full review of his bidding program updates may be found here:
http://www.vgm.com/blog/index.php/category/regulatory/
...
read more...
Power Wheelchair Help from Peggy
Added: Friday, January 13, 2012
For an updated checklist for PMDs click here.
Any questions contact:
Peggy Walker, RN
800-401-3643
peggy.walker@vgm.com
...
read more...
Changes in Round 2 competitive bid items below.
Added: Sunday, January 8, 2012
Three DMEPOS Competitive Bidding Announcements
Thanks to many industry leaders for their hard work, and continued dedication to working together, a few delays have been announced for this new round of CB items. This is at at least some relief for complex rehab providers.
K0005s (Ultra light weight wheelchairs)
E0986 (Power assist)
E1030 (w/c Vent Tray)
See note below.
After consideration of feedback from stakeholders, CMS has removed ultra lightweight manual wheelchairs, gimbaled ventilator trays, and push activated power assist devices from the standard wheelchair product category for Round 2. CMS expects...
read more...
NCART Releases New CRT Video -- Also Updates CRT Educational Materials
Added: Friday, January 6, 2012
NCART Members and Friends,
Today NCART is releasing a new educational video entitled “Complex Rehab Technology- Essential for health. Essential for life”. Click here for a copy of the press release.
The 11 minute video provides an introduction to Complex Rehab Technology (CRT) from the perspectives of individuals that rely on CRT for their health and independence, physicians that prescribe it, and consumer organizations that work to protect access. Along with an introduction to CRT, the video also highlights policy changes that are needed to provide adequate access.
read more...
Important VGM Bid Preparation Worksheet Update
Added: Friday, January 6, 2012
CMS has acknowledged an error in its official bid limits in the Round 2 Bid Preparation Worksheets. They have revised 14 Healthcare Common Procedure Coding System (HCPCS) codes for power wheelchairs (K0813 through K0829). The previous bid limits listed in the worksheet were erroneously based on 150 percent of the actual bid limits.
VGM's bid calculator worksheets, previously distributed, included the CMS 150% bid limit on these PMD codes.
In addition, four adjustable seat cushion codes (E2622 through E2625) have been removed from the Round 2 standard wheelchairs product category. The Competitive...
read more...
Update - Pre-pay Review on PMD's
Added: Tuesday, January 3, 2012
PMD pre-pay review delayed CMS will give 30 day notice before initiating.
This means it will more than likely start April 4th -- any time delays like this happen at last minute it usually becomes effective the first of next quarter.
Now we can get prepared for it and they will give us 30 day notice.
https://www.cms.gov/CERT/02_Demonstrations.asp
Medicare’s Prepayment review and Prior Authorization Demonstration Project for Power Mobility Devices will take effect on January 1st 2012. Please make sure you...
read more...