Updates from the Medicare Learning Network… [cid:[email protected]]
§ “DMEPOS Competitive Bidding Procedures for Upgrades” Fact Sheet § “New Home Health Claims Reporting Requirements for G Codes Related to Therapy and Skilled Nursing Services” § “Rural Health Clinics and Federally Qualified Health Centers Billing Guide” § Three New Fact Sheets on Oxygen Therapy Supplies, Positive Airway Pressure Devices, and Cardiac Pacemakers >From the Medicare Learning Network: “DMEPOS Competitive Bidding Procedures >for Upgrades” Fact Sheet [↑] The “Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Billing Procedures for Upgrades” Fact Sheet is now available to download, free of charge, from the Medicare Learning Network(r). Once the DMEPOS Competitive Bidding Program becomes effective on Sat Jan 1, 2011, beneficiaries with Original Medicare who obtain competitively bid items in competitive bidding areas (CBAs) must obtain these items from a contract supplier for Medicare to pay, unless an exception applies. This fact sheet contains helpful information on Competitive Bidding Program rules that apply when a beneficiary wants to obtain an upgrade - that is, an item or a component of an item that exceeds the beneficiary’s medical need. It includes information on which DMEPOS suppliers can provide the item, how the item will be paid, beneficiary liability, and Advance Beneficiary Notice (ABN) requirements. To view the fact sheet, please visit the DMEPOS Competitive Bidding Educational Resources page at http://www.cms.gov/DMEPOSCompetitiveBid/04_Educational_Resources.asp. Scroll to “Downloads” and select “DMEPOS Competitive Bidding Fact Sheets.” >From the Medicare Learning Network: “New Home Health Claims Reporting >Requirements for G Codes Related to Therapy and Skilled Nursing Services” [↑] The Medicare Learning Network(r) has released MLN Matters Article #MM7182, “New Home Health Claims Reporting Requirements for G Codes Related to Therapy and Skilled Nursing Services,” to inform home health agencies that they are required to report additional, and more specific, data about therapy nursing visits in home health claims. This requirement is based on Change Request #7182 and is effective for home health episodes beginning on or after Sat Jan 1, 2011. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM7182.pdf. >From the Medicare Learning Network: “Rural Health Clinics and Federally >Qualified Health Centers Billing Guide” [↑] The Medicare Learning Network(r) has released MLN Matters Special Edition Article #SE1039, “Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide,” to explain how RHCs should bill for certain preventive services under the Affordable Care Act and what information is required to develop and implement a Prospective Payment System (PPS) for Medicare FQHCs. This article is based on Change Requests #7038 and #7208 and is available at http://www.cms.gov/MLNMattersArticles/downloads/SE1039.pdf. >From the Medicare Learning Network: Three New Fact Sheets on Oxygen Therapy >Supplies, Positive Airway Pressure Devices, and Cardiac Pacemakers [↑] The Medicare Learning Network(r) has developed three new fact sheets to provide education on common Comprehensive Error Rate Testing (CERT) errors related to oxygen therapy supplies, positive airway pressure (PAP) devices, and cardiac pacemakers. These educational products are available in downloadable format at the URLs listed below: § “Oxygen Therapy Supplies: Complying with Documentation & Coverage Requirements” - includes a checklist of the documentation needed to support claims submitted to Medicare for oxygen therapy supplies. For more details, visit http://www.cms.gov/MLNProducts/downloads/OxgnThrpy_DocCvg_FactSheet_ICN904883.pdf. § “Cardiac Pacemakers” - provides a list of common errors identified through the CERT Review Process and the covered indications for dual-chamber pacemakers. For more details, visit http://www.cms.gov/MLNProducts/downloads/CERT_Pmaker_FactSheet_ICN905144.pdf. § “Positive Airway Pressure (PAP) Devices: Complying with Documentation & Coverage Requirements” - includes a checklist of the documentation needed to support claims submitted to Medicare for PAP devices. For more details, visit http://www.cms.gov/MLNProducts/downloads/PAP_DocCvg_FactSheet_ICN905064.pdf. For additional resources that educate Fee-For-Service providers about common billing errors and other improper activities identified through CMS’s claim review programs, including CERT, please visit the MLN Provider Compliance web page at http://www.cms.gov/MLNProducts/45_ProviderCompliance.asp. January Flu Shot Reminder Flu Season is Here! While seasonal flu outbreaks can happen as early as October, flu activity usually peaks in January. This year’s vaccine will protect against three different flu viruses, including the H1N1 virus that caused so much illness last flu season. The risks for complications, hospitalizations and deaths from the flu are higher among individuals aged 65 years and older. Medicare pays for the seasonal flu vaccine and its administration for seniors and others with Medicare with no co-pay or deductible. Health care workers, who may spread the flu to high risk patients, should get vaccinated too. Don’t forget to immunize yourself and your staff. Protect your patients. Protect your family. Protect yourself. Get Your Flu Vaccine - Not the Flu. Remember - Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug. For information about Medicare’s coverage of the influenza vaccine and its administration, as well as related educational resources for health care professionals and their staff, please visit the following CMS websites: http://www.cms.gov/MLNProducts/Downloads/Flu_Products.pdf and http://www.cms.gov/AdultImmunizations. ----------------------------------------------------------------------------------------------------- Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. If you know someone who would like to subscribe to a Medicare Fee-For-Service (FFS) provider listserv, go to (http://www.cms.gov/prospmedicarefeesvcpmtgen/downloads/Provider_Listservs.pdf). If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/wa.exe?INDEX) to unsubscribe or to leave the appropriate listserv. Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. Responses to this email are not routed to CMS personnel. Inquiries may be sent by going to (http://www.cms.gov/ContactCMS). Thank you.
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