POE Update
Jody Whitten, Noridian Administrative Services
Standard Power Wheelchairs
Effective for items provided on or after January 1, 2011, standard power wheelchairs (K0813-K0831) K0898) must be furnished on a monthly rental basis like other capped rental durable medical equipment (DME). Q & A was posted 11/11/10.
Immunosuppressive Drugs
Immunosuppressive drugs are allowed and covered by the DME MAC for Medicare covered transplant only. Review indicates suppliers are using the KX improperly. Should only be used if:
- The supplier obtains from the order ding physician the date of the organ transplant; and
- The beneficiary was enrolled in Medicare Part A at the item of the organ transplant(whether or not Medicare paid for the transplant): and
- The transplant date precedes the date of service on the claim.
Reminder article posted 11/11/
Testing suppliers above standard allowance
Glucose monitor testing supplier over standard allowance without documentation to support additional criteria for excessive supplies maybe billed as an upgrade using the GA/GK modifier guidelines. Article posted 11/11.
Oral Appliance for OSA
LCD has been finalized and is set to go live on Thursday.
Endeavor
Suppliers are encouraged to register for Endeavor which offers free, online access to patient eligibility, claim status, and remittance advices. The hours of availability include:
- Eligibility: 24 hours/day, 7 days /week
- Claim status and remittance advices 6 a.m.-6 p.m. Monday-Friday; 7 a.m. – 3 p.m. Saturday and Sunday
Suppliers, billers and third parties may register for Endeavor.
Each person accessing Endeavor must register for their own User ID. User ID’s cannot be used by more than one person.
To register, go to the claims page of our website. Many suppliers are already taking advantage of this tool and we highly encourage you all to do so as well!
Education Updates
- Conducted a week of FTF events in Irvine, California. November 2-4. Total registered was about 300, but total attended 150. Focus was high CERT policies.
Glucose Monitor and Testing Supplies
Enteral Nutrition
Positive Airway Pressure Devices
Oxygen and Oxygen Equipment
Wheelchair Series… Manual, Power, Option and Accessories, and Seating.
- Same Series is scheduled for January 18-20, 2011 in Riverside, CA.
Maybe cancelled if attendance doesn’t increase.
- Education is emphasizing Place of Service at FTF events and during Documentation Workshops per DAC request.
- CERT Education has been a big focus, both policies with high CERT errors and specific suppliers with high CERT errors.
Specific to suppliers we have been conducting site visits or personal phone calls to discuss these errors and offer specific education for the top 3-5% of suppliers.
- Since out last meeting in August NAS DME has conducted:
42 WebEx
3 ACT (2 General and 1 Topic Specific Enteral)
Attended Big Sky AMES in September
MAMES in October
AOPA end of September beginning of October 9/29 – 10/2/10
Vision Expos for the first time in October 10/7 to 10/9/2010
Reminders :
National CERT Task Force Meeting @ 11:00-12:30. Dr. Perez and CMS will attend.
RAD Documentation Session at 1:00 p.m.
Diabetic Care/Supplies presentation with Part B educators, January 26th at 11:00 a.m. CST.