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Durable Medical Equipment Medicare Administrative Contractors April 9, 2015
NHIC, Corp. A CMS CONTRACTOR
Medicare DME MAC Consultants
• Judie Roan – NHIC, Corp. – Jurisdiction A
• Tamara Hall – National Government Services – Jurisdiction B
• Angie Cooper – CGS Administrators, LLC – Jurisdiction C
• Colleen Harryman – Noridian Healthcare Solutions– Jurisdiction D
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Disclaimer
The Medicare contractors have produced this material as an informational reference for providers furnishing services in our contract jurisdiction. The DME MACs employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the CMS Web site at http://www.cms.gov.
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Acronyms Acronym Term
ABN Advance Beneficiary Notice of Noncoverage
ADMC Advance determination of Medicare coverage
ADR Additional documentation request
CERT Comprehensive Error Rate Testing (contractor)
CMN Certificate of Medical Necessity
CMS Centers for Medicare & Medicaid Services
DMECS Durable Medical Equipment Coding System
DME MAC Durable Medical Equipment Medicare Administrative Contractor
DMEPOS Durable medical equipment, prosthetics, orthotics, and supplies
DO Doctor of Osteopathy
DWO Detailed Written Order
ICD-9 International Classification of Diseases, 9th Revision
1CD-10 International Classification of Diseases, 10th Revision 5
Acronyms Acronym Term
IOM (CMS) Internet-Only Manual
IVR Interactive voice response (system)
MD Doctor of Medicine
MLN Medicare Learning Network
NPI National Provider Identifier
RUL Reasonable useful lifetime
PA Physician assistant
PDAC Pricing, Data Analysis, and Coding (contractor)
PECOS Provider Enrollment Chain & Ownership System
POD Proof of delivery
PTAN Provider Transaction Access Number
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Who is a Medicare Supplier?
• Supplies DMEPOS items • Assigned a NPI • Assigned a PTAN via the National Supplier
Clearinghouse – http://www.palmettogba.com/palmetto/providers.nsf/
DocsCatHome/National%20Supplier%20Clearinghouse
– 1-866-238-9652 from 9 a.m. until 5 p.m. ET
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Agenda
• Signature Requirements • Technical Components of Documentation • Clinical Components of Documentation • ICD-10 • Resources • Questions
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Signature Requirements
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Physician Signatures
• Medicare requires a legible identifier for services provided/ordered
• Handwritten or electronic signature – Stamped signatures and signature dates are not
acceptable • Order is considered invalid if missing physician’s
signature • CMS IOM 100-08, Chapter 3, Section 3.3.2.4
– http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c03.pdf
• MLN Matters 6698 – http://www.cms.gov/Outreach-and-Education/Medicare-
Learning-Network-MLN/MLNMattersArticles/downloads/MM6698.pdf
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Legible Identifiers
Handwritten Signature • A mark or sign by an
individual to signify knowledge, approval, acceptance, or obligation
– Stamped signatures and signature dates are not acceptable
• Illegible signature with printed physician name and credentials meets legible identifier requirements
Electronic Signature • Some examples of acceptable
notations of electronic signatures (not all inclusive list):
– Electronically signed by – Authenticated by – Approved by – Completed by – Finalized by – Signed by – Validated by – Sealed by
• A typed signature, without indication that the document was dictated by treating/ordering/rendering provider, is not acceptable, even if typed on letterhead
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Signature Logs
• Should include – Physician printed name – Physician signature – Physician initials – Credentials and NPI (encouraged)
• Provide in audit situation
PRINTED NAME SIGNATURE/INITIALS CREDENTIALS
Dr. John Smith Dr.John Smith/JS M.D. M.D.
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Signature Logs vs. Attestation Statements
Signature Log • Used when signature is
illegible – Cannot be used when a
signature is missing
Attestation Statement • Used when signature is missing
on medical records – Cannot be used when signature
is missing from an order • Dispensing • Detailed Written Order • CMN
– Cannot be used to provide medical necessity
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Technical Components of Documentation
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Dispensing & Detailed Written Orders
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Authorized to Order
• Treating physician • Nurse practitioner or clinical nurse specialist • Physician assistant • Eligible medical professional who is enrolled in
PECOS • Refer to the DME MAC Web sites for additional
information
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Dispensing Order
• Obtained prior to dispensing item(s) • Acceptable formats:
– Verbal – Written
• Photocopy • Facsimile image • Electronically maintained • Original “pen-and-ink” document
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Requirements for Dispensing Order
• Beneficiary name • Description of the item(s) • Prescribing physician’s name • Date of the order and the start date, if the start date
is different from the date of the order – Use the date the supplier is contacted by the
physician (for verbal orders) or the date entered by the physician (for written dispensing orders)
• Physician signature (if a written order) or supplier signature (if verbal order)
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Valid Dispensing Order
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Detailed Written Order
• Obtained prior to billing Medicare • Acceptable formats:
– Written • Photocopy • Facsimile image • Electronically maintained • Original “pen-and-ink” document
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DWO Requirements
• Beneficiary name • Physician’s name • Date of the order and the start date, if start date is
different from the date of the order • Detailed description of the item(s)
– Narrative description or a brand name/model number – Quantity to be dispensed – Number of refills
• Physician signature and signature date • Signature and date stamps are not allowed
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Dates on DWOs
• Order date – The date is pulled from the dispensing order – Required on all DWOs
• Start date – If ordering physician specifies a different date than the order date
• Signature date – Someone other than the physician may complete the detailed
description of the item. However, the treating physician must review the detailed description and personally sign and date the order to indicate agreement. – CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.2.3
• Majority of DWOs require an order date and a signature date since suppliers typically complete the detailed description on DWO
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Valid Detailed Written Order
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Order Changes
• CMS IOM Publication 100-08, Chapter 5, Section 5.3.1: – Physician must line through error – Initial, and – Date the correction
• If not noted, the supplier should obtain a new order
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When is a New Order Required?
• There is a change of supplier • There is a change in the item(s) or amount
prescribed • There is a change in the length of need or a
previously established length of need expires • An item is replaced • State law requires a prescription renewal
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Orders & Repairs/ Replacements
• Repair – A new order is not required
• Replacement – A new order is required – Prior to Reasonable Useful Lifetime (RUL)
• Only allowed if lost, stolen, or irreparably damaged – The reason for replacement must be documented and
may be supported by the following types of documentation:
– Medical records – Police reports or fire reports – Written explanations from the beneficiary
• Normal wear and tear not acceptable even if repair cost more than replacement 26
Written Dispensing Orders vs. DWOs
Dispensing Orders • Beneficiary name • Prescribing physician’s
name • Date of the order and the
start date, if start date is different from the date of the order
• Description of the item(s) • Physician signature
DWOs • Beneficiary name • Prescribing physician’s name • Date of the order and the start
date, if start date is different from the date of the order
• Detailed description of the item(s) – Item(s) to be dispensed – Quantity to be dispensed – Number of refills
• Physician signature and signature date
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Top Errors Resolutions DWOs are signed by the treating physician after the date of claim submission.
1. Prior to claim submission review all required documentation to ensure that this requirement is met.
2. An appeal may be requested for the denied services.
Dispensing order is the only order submitted for items billed.
1. Suppliers may dispense an item based off the dispensing item HOWEVER the supplier must follow up with the treating physician to secure a DWO.
2. An appeal may be requested for the denied claim.
DWO does not include a complete listing of the items provided.
1. Review the DWO to ensure that all items provided are indicated on the DWO prior to presenting the DWO to the physician for signature.
2. An appeal may be requested for the denied claim.
Top Errors with Orders
Dispensing and Detailed Written Orders Misconceptions 1. The DWO from the treating physician can be
secured at any time. – False, all items billed to the Medicare program for
payment require the supplier to secure a DWO prior to claim submission.
2. The DWO should only indicate the main components of the prosthetic device.
– False, the DWO must contain an itemized detailed description of all items (including) components provided.
3. Diagnosis information is required on the order. – False, orders do not require diagnosis information.
4. Suppliers may solicit for physician orders. – False, per CMS IOM Publication 100-01, Chapter 1,
Section 20.3.1, suppliers may not solicit physicians for orders.
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Request for Refill
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Request for Refill
• A routine refill prescription is not needed • Contact with the beneficiary or designee must be
no sooner than 14 calendar days prior to delivery/shipping date
• Contact may be written or telephone
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Request for Refill
• Obtains in-person at a retail store – Signed delivery slip or a copy of the itemized sales receipt is
sufficient documentation of a request for refill • Delivered to the beneficiary
– Written document from beneficiary or written record of phone conversation
• Beneficiary’s name or authorized representative if different than the beneficiary
• A description of each item that is being requested (Examples – Bras, camisoles, other mastectomy garments)
– The supplier should assess whether the supply item remains functional – Replacement should be provided only when the item is no longer
functional – The supplier should document the condition of the item being replaced in
sufficient detail to indicate why the replacement is necessary at that time • Date of refill request
Note: A retrospective attestation statement by the supplier or beneficiary is not sufficient.
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Request for Refill Tips
• Call-in requests for refills – Date of service is date the items are picked up, not
the date the refill was completed • Forms with yes/no answers are not sufficient
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Question on Request for Refill
1. If the ordering physician does not indicate refills on the dispensing order or in the medical record, but just ordered four bras, are suppliers to interpret this as to dispense four bras, no refills or one bra every three months? Yes, either is acceptable.
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Proof of Delivery
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Proof of Delivery
• Supplier Standard #12 • Verifies beneficiary received DMEPOS item • Must be available upon request • Can be signed by beneficiary or designee
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Direct Delivery to the Beneficiary by Supplier (Method 1)
• Proof of Delivery must be a signed and dated delivery slip which includes: – Beneficiary’s name – Delivery address – Sufficiently detailed description to identify the item(s) being
delivered (e.g., brand name, serial number, narrative description) – Quantity delivered – Dated delivered
• May be entered by the beneficiary, designee or the supplier
– Beneficiary (or designee) signature • Date of delivery on delivery slip must be the date actually
received • Date Received = Date of Service on Claim
Note: If both a supplier entered date and beneficiary/designee signature date are present, the beneficiary/designee entered date is considered the delivery date and date of service.
Valid Proof of Delivery - Method I
• Beneficiary’s name
• Delivery address
• Sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description)
• Quantity delivered
• Dated delivered
• Beneficiary/ designee signature
L8000 Amoena Angela Soft Cup 0766 36C White 2
12/30/13
Delivery via Shipping or Delivery Service (Method 2)
• Proof of delivery must be a complete record tracking the item(s) from the DMEPOS supplier to the beneficiary
• An example of acceptable proof of delivery would include both the supplier’s own detailed shipping invoice and the delivery service’s tracking information
• The supplier’s record must be linked to the delivery service’s record by some clear method
Delivery via Shipping or Delivery Service (Method 2)
• The proof of delivery record must include: – Beneficiary’s name – Delivery address – Delivery service’s package identification number, supplier invoice
number or alternative method that links supplier’s delivery documents with the delivery service’s records
– Sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description)
– Quantity delivered – Date delivered – Evidence of delivery
• Shipping Date = Date of Service on Claim • Suppliers may also utilize a return postage-paid delivery
invoice from the beneficiary or designee as a form of proof of delivery. This type of proof of delivery record must contain the information specified above.
Valid Proof of Delivery - Method II
Amoena Angela Soft Cup 0766 36C White 2 L8000
Amoena Angela Soft Cup 0766 36C White
Delivery to Nursing Facility on Behalf of a Beneficiary (Method 3)
• When a supplier delivers items directly to a nursing facility, the documentation described in Method 1 is required
• When delivery or mail order is used to deliver items to a nursing facility, the documentation described in Method 2 is required
• Regardless the method of delivery, for those beneficiaries that are residents of a nursing facility, information from the nursing facility showing that the item(s) delivered for the beneficiary’s use were actually provided to and used by the beneficiary must be available upon request
Proof of Delivery
• A Supplier may deliver a DMEPOS item to a beneficiary two (2) days prior to discharge for fitting or training
• Suppliers may not bill for DMEPOS items used by beneficiary prior to discharge from the hospital or Medicare Part A nursing facility stay
• Date of Discharge = Date of Service • Place of Service (POS) = 12 (Home)
• Payment for any HCPCS code listed in the External Breast Prosthesis policy is included in the payment to a hospital if: – The item is provided to a beneficiary during an
inpatient hospital stay prior to the day of discharge; and
– The beneficiary uses the item for medically necessary inpatient treatment or rehabilitation
Providing Items in Hospital
• Beneficiary has 100 days that are covered under Medicare Part A – Considered Medicare Part A Covered Stay
• Payment for any HCPCS code listed in the External Breast Prosthesis policy is included in the payment to a Skilled Nursing Facility if: – The item is provided to a beneficiary during Medicare
Part A covered Skilled Nursing Facility stay prior to the day of discharge; and
– The beneficiary uses the item for medically necessary inpatient treatment or rehabilitation
Provided Items in a Skilled Nursing Facility
• Beneficiary exhausted 100 days of Medicare Part A covered stay – Medicare Part A has a claim for discharged or no-pay
stay • Payment for any HCPCS code listed in the External
Breast Prosthesis
Providing Items in Skilled Nursing Facility or Nursing Facility
• Payment for any HCPCS code listed in the External Breast Prosthesis medical policy delivered to a beneficiary in a hospital or Skilled Nursing Facility is eligible for coverage if: – Prosthetic is medically necessary for a beneficiary after
discharge from a hospital or Part A covered Skilled Nursing Facility stay; and
– Prosthetic is provided to the beneficiary within two days to prior to anticipated discharge to home; and
– Prosthetic is not needed for inpatient treatment or rehabilitation, but is left in the room for the beneficiary to take home
• If these conditions are met, the claim is billed with: – Date of service = Date of discharge – Place of service = 12 (beneficiary’s home)
Two Day Rule
Proof of Delivery
• Date of service and date of delivery – Method 1
• Date of service = date of delivery – Method 2
• Date of service = ship date – Method 3
• Date of service depends on Method of delivery
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Top Errors Resolutions The delivery date does not match the DOS billed.
1. This error can not be corrected. 2. An appeal may be requested for the denied
services. The items billed do not match the delivery slip.
1. Review the delivery slip for accuracy prior to requesting the beneficiary’s or authorized representatives signature.
2. An appeal may be requested for the denied claim.
The beneficiary full address or delivery address is not on the POD record.
1. Upon appeal obtain and provide the screen shot for that delivery that has the full delivery address.
2. If unable to provide this, the error cannot be corrected for this claim.
Top Errors with Proof of Delivery
Proof of Delivery Misconceptions
1. The proof of delivery does not require a description of items delivered.
– False, detailed description (e.g., brand name, serial number, narrative description) of the items being delivered is required.
2. If a beneficiary picks their items up at a store front, proof of delivery is not applicable. – False, proof of delivery is required for all items
billable to Medicare. 3. A signature is required for all proof of
deliveries. – False, signatures are required for Method 1 however,
Method 2 requires evidence of delivery which may or may not be a signature.
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Advance Beneficiary Notice of Noncoverage (ABN)
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ABNs
• Situations requiring an ABN: – Not medically reasonable and necessary – Prohibited, unsolicited telephone contacts – No supplier number
• Allows beneficiary to make informed decision • Protects supplier from liability • Properly execute prior to delivery of item(s)
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Modifier Usage with ABNs
• Noncovered versus not medically necessary – GY−Noncovered – GA−Not medically necessary/ABN on file – GZ−Not medically necessary/no ABN – GA and GY never reported on same claim line
• No physician’s order – Modifiers EY and GA when no order was received
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Questions on ABNs and Upgrades
• If a supplier is submitting a non-assigned claim, is an ABN required in order to hold the beneficiary liable for the full amount of the supplier charges of service? – No, an ABN is not required to hold the beneficiary liable for the
full charge if Medicare makes payment on the claim. If the claim is expected to be denied, yes the supplier will need to execute an ABN to hold the beneficiary liable for the charges.
• If a beneficiary is requesting to purchase breast prostheses or garments via cash, is a supplier required to execute an ABN? – Yes, suppliers should execute an ABN when a beneficiary
requests items that do not meet Medicare’s coverage criteria and they request to pay for the items via cash. The beneficiary should select option two in section G of the ABN.
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Questions on ABNs and Upgrades
• Are suppliers able to collect the difference in what Medicare allows and what the supplier charges for a L8000 if an ABN has been properly executed? – Mastectomy bras are not eligible to be billed as upgrades so an
ABN is not applicable. The Medicare allowed amount is all a participating supplier can receive as payment in full when billing for the L8000. Non-participating suppliers have the option to bill mastectomy bras as non-assigned claims in order to receive full payment directly from the beneficiary—in these cases, an ABN is not required.
• Are suppliers able to bill items as upgrades due to the item the beneficiary received costs more than what Medicare allows? – No. Cost is not sufficient to justify an upgrade.
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Questions on ABNs and Upgrades
• Are suppliers able to submit breast prostheses bras as upgrade billing? If so, what are the appropriate steps to take to ensure correct billing? – Upgrades involve situations in which the upgraded item or
component is more than what is medically necessary. For items with a different HCPCS code than the item that will be covered by Medicare, this distinction between products is easy to determine. Differing products contained within the same HCPCS code generally are considered as equivalent to one another. A difference in pricing for items classified within the same HCPCS code is not sufficient to justify an upgrade. For bras coded within the same HCPCS code, upgrade billing is not permitted.
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• Upgraded with an ABN – Line 1 L8031LTGA $425.00
• Will result in PR-50 denial, with $75.00 payment responsibility – Line 2 L8030LTGK $350.00
• Will process for payment
• Upgrade without an ABN – Line 1 L8031RTGZ $425.00
• Will result in CO-50 denial, with $75.00 payment responsibility – Line 2 L8030RTGK $350.00
• Will process for payment
• Free upgrade – Line 1 L8030LTGL $350.00 – NTE or Item 19: L8031 Balance Contact Delta Amoena
284B 57
Upgrade Billing
• Blank (C) Identification Number: – Enter an identification number for the beneficiary that helps to link the
notice with a related claim when applicable. The beneficiary’s Medicare number or HICN will no longer be used.
• Blank (D): – Explain what item is not medically necessary
• L8031 – Balance Contact Delta 284B prosthesis
• Blank (E) Reason Medicare May Not Pay: – Explain why the item is not covered by Medicare.
• Medicare does not consider coverage for the prosthesis that you have received.
• Blank (F) Cost: – Estimated cost of what the beneficiary will have to pay out of pocket for
the item • Valid once beneficiary/designee signs and dates ABN. • Valid for one year from signature date.
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ABN Completion Reminders
Continued Use and Continued Need
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Continued Use • Continued use describes the ongoing utilization of supplies (bras,
camisoles, other mastectomy garments) by a beneficiary. • Suppliers are responsible for monitoring utilization of supplies. No
monitoring of purchased is required. Suppliers must discontinue billing Medicare when ongoing supply items are no longer being used by the beneficiary.
• Beneficiary medical records or supplier records may be used to confirm that a DMEPOS item continues to be used by the beneficiary. Any of the following may serve as documentation that an item submitted for reimbursement continues to be used by the beneficiary:
1. Timely documentation in the beneficiary's medical record showing usage of the item, related supplies.
2. Supplier records documenting the request for refill/replacement of supplies in compliance with the Refill Documentation Requirements .
3. Timely documentation is defined as a record in the preceding 12 months unless otherwise specified elsewhere in this policy.
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Continued Need • For all DMEPOS items, the initial justification for medical need is established
at the time the item(s) is first ordered; therefore, beneficiary medical records demonstrating that the item is reasonable and necessary are created just prior to, or at the time of, the creation of the initial prescription. For purchased items or for initial months of ongoing supplies, information justifying reimbursement will come from this initial time period. Entries in the beneficiary's medical record must have been created prior to, or at the time of, the initial DOS to establish whether the initial reimbursement was justified based upon the applicable coverage policy.
• For ongoing supplies, in addition to information described above that justifies the initial provision of the item(s) and/or supplies, there must be information in the beneficiary's medical record to support that the item continues to be used by the beneficiary and remains reasonable and necessary. Information used to justify continued medical need must be timely for the DOS under review. Any of the following may serve as documentation justifying continued medical need:
1. A recent order by the treating physician for refills 2. A recent change in prescription 3. Timely documentation in the beneficiary's medical record showing usage of the
item. – Timely documentation is defined as a record in the preceding 12 months unless
otherwise specified elsewhere in the policy.
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Clinical Components of Documentation
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Medical Records
• Beneficiary’s medical record must contain sufficient documentation to substantiate the necessity of: – Type of prosthetic/garment – Quantity – Frequency of use
• Should include: – Beneficiary’s diagnosis – Duration of beneficiary’s condition – Clinical course (worsening or improvement) – Prognosis, nature and extent of functional limitations – Other therapeutic interventions, results, past
experience, etc.
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Additional Information for Medical Records
• Consider the following with an evaluation: – Physical assessment – Circulation – Skin integrity – Range of motion – Muscle strength – Manual dexterity – Posture and balance – Sensation – Anatomic contours
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Follow-up with Beneficiary
• Wear schedule/tolerance • Comfort • Ability to don and doff • Function level • Skin condition
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ICD-10
ICD-10 Background
• CMS is in the process of implementing ICD-10. All covered entities must be fully compliant on October 1, 2015. – Covered entities:
• Providers/Suppliers • Billing Services • Clearinghouses • Software Vendors
• For dates of service on and after October 1, 2015, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) are required to use the ICD-10 code sets. – Impacts the entire health care community
ICD-10 Updated LCDs & PAs
• Local Coverage Determinations (LCD) and Policy Articles (PA) have been updated – ICD-9 and ICD-10 LCDs and PAs are assigned new
ID numbers to keep them separate • Not considered new policies
– Coding revisions do not change the intent of the coverage/non-coverage
Steps to Locate ICD-10 Future LCD & PA 1) Visit http://www.cms.gov/medicare-coverage-database/indexes/national-and-
local-indexes.aspx . 2) On the CMS MCD Homepage, click on the “Indexes” tab at the top of the
page; 3) Select “Local Coverage”; 4) Select one of the three display options for LCDs (“LCDs by Contractor,”
“LCDs by State,” or “LCDs Listed Alphabetically”); 5) If you choose LCDs by Contractor, click on that link; 6) Select a MAC; 7) In the Document types, checkmark the square for “Future LCDs/Future
Contract Number LCDs”; 8) Click the “Submit” button; 9) Click on the Contractor name; and 10) A list of Future Effective LCDs will display. Those LCDs with a 10/01/2015
Effective Date are ICD-10 LCDs. "How to Access Updates to ICD-10 Local Coverage Determinations in the CMS Medicare Coverage Database," is available at http://go.cms.gov/1pcSQW0
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Diagnosis Indicator for Paper Claims
• Enter diagnosis indicator between the vertical, dotted lines for Item 21 – 9 – ICD-9-CM diagnosis – 0 – ICD-10-CM diagnosis
• ICD-10-CM codes are reported for claims with dates of services on or after October 1, 2015
• Medicare Claims Processing Manual, Chapter 26: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf
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ICD-10 and the CMS 1500 Form
ICD-10 CMS Calls
• CMS National Provider Call – Registration is required – Live Q&A session will follow presentation
• Visit CMS’ website for dates/times of the next CMS sponsored ICD-10 Teleconference – CMS Website
“Road to 10” • Small Physician’s Practice Route to ICD-10 • No-cost tool that will help you:
– Get an overview of ICD-10 – Explore Specialty References – Create your personal action plan
• Resources: – ICD-10 Overview – Physician Perspectives – Webcasts – FAQ – Quick References – Template Library – Events
• http://www.roadto10.org
Additional ICD-10 Resources
• Acknowledgement & End-to-End Testing MLN Matters® Article MM8858, "ICD-10 Testing - Acknowledgement Testing with Providers” MLN Matters® Special Edition Article SE1409, “Medicare FFS ICD-10 Testing Approach”
• Centers for Medicare and Medicaid Services (CMS) ICD-10 website http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10
• Common Electronic Data Interchange (CEDI) website http://www.ngscedi.com/ngs/portal/ngscedi/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfGjzOK9DS1NPP29DbwsggOdDRz9PbwDjAzdjAyMjfQLsh0VATBjgCA!/
Resources
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CMS Resources
• CMS IOMs – http://www.cms.gov/Manuals/IOM/list.asp
• MLN
– http://www.cms.gov/MLNProducts/
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Obtaining Same and Similar Information
• HCPCS codes located in External Breast Prosthesis medical policy – Speak with Customer Care Representative with DME
MAC – Beneficiary not required to provide written or verbal
authorization • Suppliers should have dispensing order for
beneficiary
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NHIC, Corp. – Jurisdiction A Resources
• http://www.medicarenhic.com/dme/default.aspx • Interactive Voice Response (IVR) - 866-419-9458
– Monday - Friday 6:00 AM - 7:00 PM and Saturday 6:00 AM - 3:00 PM EST
• Provider Services Portal (PSP) – http://www.medicarenhic.com/dme/psphome.aspx
• Customer Service Representatives - 866-590-6731 – Monday through Friday 8:00 a.m. until 5:00 p.m. EST
• LCDs and Policy Articles – http://www.medicarenhic.com/dme/mrlcdcurrent.aspx
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NHIC, Corp. A CMS CONTRACTOR
National Government Services – Jurisdiction B Resources
• http://www.NGSMedicare.com • Policy Tab
• Medical Policy Center • Policy Education Topics
• NGSConnex: http://www.NGSConnex.com • http://www.MedicareUniversity.com
– External Breast Prostheses Computer Based Training course DME-C-0058
• Provider Contact Center: 1-866-590-6727 – Monday–Friday: 8:30 a.m.–5:30 p.m. ET – Training Closure Time: Fridays 2:30–4:30 p.m. ET
• IVR: 1-877-299-7900
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CGS Administrators, LLC – Jurisdiction C Resources • http://www.CGSMedicare.com • IVR Unit: 1.866.238.9650 • myCGS web portal:
– http://www.cgsmedicare.com/jc/mycgs/index.html • Customer Service: 1.866.270.4909
– M-F 7:00 am - 5:00 pm CST • Telephone Re-openings: 1.866.813.7878
– M-F 7:00 am – 5:00 pm CST • LCDs and Policy Articles:
– http://www.cgsmedicare.com/jc/coverage/LCDinfo.html • Jurisdiction C Supplier Manual:
– http://www.cgsmedicare.com/jc/pubs/supman/index.html
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Noridian Healthcare Solutions– Jurisdiction D Resources
• https://www.noridianmedicare.com/dme/ • IVR, Supplier Contact Center and Telephone
Reopenings: 1-877-320-0390 – IVR: 6:00 a.m. – 8:00 p.m. CT M-F – Supplier Contact Center : 8:00 a.m. – 6:00 p.m. CT M-F – Telephone Reopenings: 8:00 a.m. – 6:00 p.m. CT M-F
• Endeavor – https://www.noridianmedicare.com/dme/claims/endeavor.html
• LCDs and Policy Articles – https://www.noridianmedicare.com/dme/coverage/lcd.html
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Questions?
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