Today, as part of the Obama administration’s work to make our health care system more transparent, affordable, and accountable, Health and Human Services (HHS) Secretary Kathleen Sebelius announced the release of new, privacy-protected data on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. The new data also show payment and submitted charges, or bills, for those services and procedures by provider. Please click here for more information.
Category: DME Information
PDAC Process to re-classify orthotic products as Off-The-Shelf
Noridian Healthcare Services reports that effective January 1, 2014, the Centers for Medicare & Medicaid Services (CMS) established 23 new HCPCS codes to describe Pre-Fabricated Off-The-Shelf (OTS) orthoses and revised the HCPCS code description for 29 existing codes describing Pre-Fabricated Custom-Fitted orthoses. These changes were outlined in the Advisory Article titled HCPCS Code Update (2014) which was posted to the PDAC website on January 3, 2014. The link is provided here for your convenience: www.dmepdac.com/resources/articles/2014/01_03_14.html
Products that are currently listed on the Durable Medical Equipment Coding System (DMECS) with any of the 29 HCPCS codes that were revised, can no longer be considered fully “code verified” by the PDAC under the new definitions. While the product(s) fits the general category of its currently designated HCPCS code, the PDAC needs to further differentiate if products are only OTS, only custom-fitted, or possibly both.
PDAC is undertaking the task of reviewing all products currently on DMECS affected by these coding changes to ensure DMECS is updated with the correct coding assignments. We are currently in the process of contacting the manufacturers of products listed on DMECS and asking them to identify which product(s) they consider as being only OTS. As we receive these responses, we will update DMECS. A coding verification application will not be required to re-classify an existing product listed on DMECS to the appropriate OTS HCPCS code.
Off-the-Shelf orthotics under Medicare are statutorily defined by law in Title 18 of the Social Security Act [section 1847(a)(2)(C)], and also in Federal Regulations at 42 CFR §414.402 asorthotics described in section 1861(s)(9) of the Act that require minimal self-adjustment for appropriate use and do not require expertise in trimming, bending, molding, assembling or customizing to fit a beneficiary.
Minimal Self-Adjustment is defined at 42 CFR §414.402 Subpart F: Minimal self-adjustment means an adjustment that the beneficiary, caretaker for the beneficiary, or supplier of the device can perform and does not require the services of a certified orthotist (that is, an individual certified by either the American Board for Certification in Orthotics and Prosthetics, Inc., or the Board for Orthotist/Prosthetist Certification) or an individual who has specialized training.
Due to the high volume of products currently listed on DMECS with these revised codes, we are contacting manufacturers in segments. If you haven’t received a notice from the PDAC yet, it will be forthcoming over the next several months. If you have products currently listed on DMECS that you consider only OTS under the new codes, PDAC is requesting that you please wait to be contacted by us before taking any action or submitting a coding verification application. As noted above, submission of a coding verification application to the PDAC is not necessary for products currently listed on DMECS to be classified as OTS.
For further questions about this process, please contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or email the PDAC by completing the DME PDAC Contact Form located on the PDAC website: www.dmepdac.com/
Senate Approves ICD-10 Delay
The Senate approved a bill yesterday evening that prevents cuts to Medicare physician payments from going into effect for one year and delays the conversion to ICD-10 diagnostic and procedure codes for at least one year. The Senate voted 64-35 in favor of the Protecting Access to Medicare Act of 2014, which the House approved last Thursday. If President Obama signs the legislation, it will be the 17th such patch that Congress has enacted since the Medicare sustainable growth-rate formula became law in 1997. The bill passed Monday would also delay enforcement of a controversial inpatient payment rule for hospitals, the “two-midnight rule,” for six months. Please click here for more information ICD-10
REVISED CMS 1500 CLAIM FORM
The National Uniform Claim Committee (NUCC) recently revised the CMS 1500 claim form. On June
10, 2013, the White House Office of Management and Budget (OMB) approved the revised form,
02/12. The revised form has a number of changes. Those most notable 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. 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
SOLICITATION BY MEDICAL EQUIPMENT SUPPLIERS
Dear Physician,
The DME MAC medical directors frequently receive complaints from physicians about various marketing schemes from DME suppliers.Some of the methods used are:
- Unsolicited orders for medical equipment or supplies, often with wording such as “We received a call from your patient Jane Doe who wants you to order…” and then lists multiple items on a pre-printed order for you to approve.
- Advertisements that Medicare will provide you with payment for referrals of patients.
- Pre-completed medical necessity forms with instructions to just “Sign and Date Here.”
Most of these schemes are obvious in their wording or their attempts to get you to approve unnecessary medical equipment and supplies.You are under no obligation to support or justify these supplier solicitations or to sign orders for items not initiated by you or that were provided by the DME supplier at a patient’s request without prior consultation. Suspected abuse may be reported to the OIG at HHSTips@oig.hhs.gov, 1-800-447-8477 or via fax at 1-800-223-2164. To read the entire letter please click here
DME INFO 