DAC 2014 Winter Meeting Noridian DME and Education Updates

  • New 1500 claim
  • Form Version 02/12 will replace the current CMS 1500 claim form, 08/05, effective with claims received on and after April 1, 2014:
  • Medicare will begin accepting claims on the revised form, 02/12, on January 6, 2014;
  • Medicare will continue to accept claims on the old form, 08/05, through March 31, 2014;
  • On April 1, 2014, Medicare will accept paper claims on only the revised CMS 1500 claim form, 02/12; and
  • On and after April 1, 2014, Medicare will no longer accept claims on the old CMS 1500 claim form, 08/05.
  • Those most notable changes for Medicare are new indicators to differentiate between ICD-9 and ICD-10 codes on a claim, and qualifiers to identify whether certain providers are being identified as having performed an ordering, referring, or supervising role in the furnishing of the service (for DME claims it will be DK - Ordering Provider). In addition, the revised form uses letters, instead of numbers, as diagnosis code pointers, and expands the number of possible diagnosis codes on a claim to 12.
  • PECOS denials
  • The issue with the ordering/referring data used for the PECOS ordering/referring physician edits that was causing erroneous denials has been corrected as of January 21, 2014. If the claim showed the ordering physician’s name (as this name appears on the CMS ordering/referring provider listing), but the claim received the N265 or N276 messages on the remittance advice, the claim may have denied in error.
  • N265 Missing/incomplete/invalid ordering provider primary identifier
  • N276 Missing/incomplete/invalid other payer referring provider identifier
  • Noridian will be providing additional details soon about how we will handle claims denied in error.
  • Fee schedule changes MLN MM8566
  • Many wheelchair accessories have been reclassified from IRP to Capped Rental. Purchase option is allowed for complex rehab accessories:
  • Effective January 1, 2014, for wheelchair accessory codes classified under the capped rental DME payment category and furnished for use with a complex rehabilitative power wheelchair (that is, furnished to be used as part of the complex rehabilitative power wheelchair), the supplier must give the beneficiary the option of purchasing these accessories at the time they are furnished. These accessory items would be considered as part of the complex rehabilitative power wheelchair (codes K0835 – K0864) and associated lump sum purchase option set forth at 42 CFR 414.229(a)(5).
  • If the beneficiary declines the purchase option, the supplier must furnish the items on a rental basis and payment will be made on a monthly rental basis in accordance with the capped rental payment rules.
  • MM8304
  • Statutory requirement to have a Face-To-Face (FTF) exam within 6 months of WOPD supporting the need (coverage criteria)
  • FTF exam is not currently being enforced
  • WOPD is being enforced as of January 1, 2014
  • If current supplier does not get a WOPD they cannot be paid if a WOPD is later received and redelivered. The beneficiary will need to go to an unrelated supplier for Medicare to allow.
  • Endeavor (encouraged Redeterminations thru portal)
  • Outreach activities
  • In-persons events. Guest speakers include CBIC and NSC. Discussed documentation requirements and appeals. Included round tables for further discussions, questions and best practices
  • 11/12 Phoenix, AZ
  • 11/14 Tucson, AZ
  • 01/14/ 2014 Pasadena
  • 01/16/2014 Bakersfield, CA
  • Upcoming 02/11/2014 Fresno, CA and 2/13/2014 San Jose, CA
  • 16 NEW DME on Demand:

A4353 / 12/19/2013
Custom Fabricated Orthoses / 12/9/2013
Five Criteria for Immuno Drug Coverage / 1/14/2014
Gastric Suction Pumps / 12/9/2013
KX Modifier / 12/3/2013
Mechanical In-Exsufflation / 12/3/2013
MLN Products / 1/8/2014
NPWT - Coverage Criteria / 12/17/2013
NPWT - Documentation / 12/17/2013
Ostomy Supplies / 1/8/2014
PECOS / 12/19/2013
Recovery Auditor: Appeal Options / 12/17/2013
Refractive Lenses - Coverage / 1/14/2014
Remittance Advice / 12/17/2013
Review Letters / 12/17/2013
Wound Suction Pumps / 1/23/2014
  • Quizzes
  • ICD-10
  • Oxygen
  • PAP
  • WebEx
  • 41 WebEx throughout January 31st:

Hospital Beds and Accessories
Positive Airway Pressure Devices
PRSS - Group 2
Respiratory Assist Devices
Spinal Orthoses
Seat Lift Mechanisms
Enteral Nutrition
Competitive Bid Modifiers (w/CBIC attendees)
Lower Limb Prosthesis
New Face-to-Face Requirements
Walkers
Oxygen and Oxygen Equipment
External Infusion Pumps
Urological Supplies
Oral Anticancer/Antiemetic Drugs
Glucose Monitors and Testing Supplies
External Breast Prosthesis
TENS
DME Endeavor
Prior Authorization of PMD
CERT Taskforce Webinar (Collaboration)
DME Modifiers
New Face-to-Face Requirements
New Face-to-Face Requirements
PRSS: Group 1
Negative Pressure Wound Therapy Pumps
General Documentation Requirements
Ostomy Supplies
Endeavor (Self Service Team)
Eye and Facial Prosthesis
Competitive Bid Modifiers
Manual Wheelchair Bases
ABN
Power Mobility Devices
Nebulizers
WC Options, Access and Seating
PECOS
DME Basics: Background
DME Basics: Documentation
New Supplier Web Tour
DME Basics: Claims and Appeals
  • 57 Electronic Supplier Visits (ESV)conducted. Requested by:
  • Suppliers request
  • MR request
  • Appeals request
  • CERT email address may also be used for information regarding DCR results
  • Please take the Website Satisfaction Survey (Foresee Survey) and when doing so keep in mind there is a separate survey for Endeavor. We want the keep to the two tools separate.