Category: Medicare

Correct Coding – Definitions Used for Off-the-Shelf, Custom Fitted and Custom Fabricated Orthotics (Braces) – Joint DME MAC Publication

Posted on by DME INFO

As part of the January 2014 HCPCS update codes were created describing certain off-the-shelf (OTS) orthotics. Some of these OTS codes parallel codes for custom fitted versions of the same items. Refer to the table at the end of this article for a listing of codes.

When providing these items suppliers must:

• Provide the product that is specified by the ordering physician, i.e. (1) type of orthosis and (2) method of  fitting and/or fabrication (OTS, custom fitted or custom fabricated).
• Be sure that the medical record justifies the need for the type of product (prefabricated versus custom  fabricated)
• Have detailed documentation in your records that justifies the code selected (e.g., fabrication methods and materials used, appropriate level of fitting and credentials of the individual fabricating and fitting the item).  For the entire article and more information please click here CODES

CMS has issued its transmittal to accompany the 2014 DMEPOS fee schedule

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CMS has issued its transmittal to accompany the 2014 DMEPOS fee schedule update at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2013-Transmittals-Items/R2836CP.html?DLPage=1&DLSort=1&DLSortDir=descending).  The reimbursement update factor this year is 1%. The transmittal includes a discussion of specific coding and pricing issues, including policies regarding the new off-the-shelf (OTS) orthotic codes.  CMS confirms in the transmittal that the 2014 fee schedule amounts for existing codes will be crosswalked to the corresponding new codes added for the items furnished OTS, so the reimbursement is the same for the new OTS codes as it is for the existing codes.

 

Please be aware that CMS also notes that “Section 1847(a)(2)(C) of the Act mandates implementation of competitive bidding programs throughout the United States for awarding contracts for furnishing off-the-shelf (OTS) orthotics which require minimal self-adjustment for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit the individual.”  The transmittal, however, does not provide any further detail in respect to when CMS might subject orthotics to competitive bidding.

CMS Launches Sunshine Website

Posted on by DME INFO

The Sunshine Law (officially known as the National Physician Payment Transparency Program) creates greater transparency around the financial relationships of manufacturers, physicians, and teaching hospitals.

The Sunshine Law requires that the following information is reported annually to CMS:

  • Applicable manufacturers of covered drugs, devices, biologicals, and medical supplies to report payments or other transfers of value they make to physicians and teaching hospitals to CMS.
  • Applicable manufacturers and applicable group purchasing organizations (GPOs) to report to CMS certain ownership or investment interests held by physicians or their immediate family members.
  • Applicable GPOs to report to CMS payments or other transfers of value made to physician owners or investors if they held ownership or an investment interest at any point during the reporting year.

CMS will collect this data, aggregate it, and publish it on a public website.  Please click here for more information: SUNSHINE

HIPAA Self Pay Rule

Posted on by DME INFO

As they prepare to meet the Sept. 23 compliance deadline for the HIPAA Omnibus Rule, security leaders at healthcare organizations are finding one requirement particularly challenging.  The rule requires organizations to accommodate patients’ requests to not disclose to their health insurer information about a product or service that they paid for out of their own pockets.  Carrying out this requirement could prove difficult, in large part, because many electronic health record, e-prescribing and other information systems lack features that easily allow segments of data to be flagged or withheld from electronic transmission.  For more information please click here HIPAA SELF PAY RULE

Ankle-Foot Orthoses/Knee-Ankle-Foot Orthoses LCD related Policy Article – Revised

Posted on by DME INFO

The related Policy Article for the Ankle-Foot Orthosis/Knee-Ankle-Foot Orthosis is being revised. The Policy Article with an effective date of January 1, 2013 included Coding Guidelines for AFOs that included a height requirement. The height requirement is being removed. The effective date for the revised Policy Article is for dates of service on or after January 1, 2013.  Please click here for announcement