MiraVista has just released the first issue of a brand new newsletter geared specifically towards your DME billing department!

We call it, The Vibe.

The 2-page newsletter contains short synopses of current billing news and tips, and is designed to be easily read and quickly digested.

Have a question you’ve been meaning to get an answer to? Ask the Expert! Each issue of The Vibe features an “Ask the Expert” column, where suppliers have the opportunity to submit questions and receive answers directly from our professional staff of billing experts.

And did we mention it’s FREE?!

You can catch the latest edition of the The Vibe here. If you like what you see, be sure to subscribe to continue receiving new editions on a monthly basis.

By coupling The Vibe with a Vista Notes subscription, you can be sure that your billing staff, managers and owners are always up to date on the ever changing DME industry.

We’d love to hear your first impressions! Comments on the new publication may be sent to:  vibe@miravistallc.com.

CMS has released the January 2012 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) reimbursement fee schedule.  CMS updates the fee schedule twice a year, in January and July.  In addition to Medicare, many other health plans like TRICARE use the reimbursement rates established in the DMEPOS Fee Schedule to set their allowed amounts. 

If you would like to lookup reimbursement rates by HCPCS code, the new fee schedule has been uploaded to the PDAC website at: https://www.dmepdac.com/dmecsapp/do/search. You may also download a complete CSV file of all HCPCS codes and their corresponding allowables at: http://www.cms.gov/DMEPOSFeeSched/LSDMEPOSFEE/list.asp#TopOfPage (Download DME12_A).

In addition to fee schedule changes, the 2012 update also includes:

• An average 3.6% increase to the allowed labor payment rate for HCPCS  K0739, L4205, and L7520;
• A new maintenance and servicing fee of $67.51 for capped oxygen concentrators and transfilling equipment (previously $65.93) – eligible to be billed once every six months, beginning six months after the equipment caps.
• A new rental payment amount of $176.06 for stationary oxygen equipment (previously $173.31).
• New, revised and deleted HCPCS effective January 1, 2012.

Full details on all of the changes and updates contained within the 2012 DMEPOS fee schedule are included in the December 2011 issue of Vista Notes. If you are not currently receiving Vista Notes, you may subscribe here.

The Department of Health and Human Services (HHS) Office of Civil Rights (OCR) recently initiated a pilot program to audit 150 covered entities under the Health Information Portability and Accountability Act. The OCR is auditing entities for compliance with the Act’s privacy, security and breach notification rules. DME suppliers (both large and small), pharmacies and hospitals are among those subject to the audit.

As of December 13, 2011, the OCR has chosen twenty entities for auditing.  The pilot program is part of the OCR’s initial steps in fulfilling its requirements under the HITECH Act to ensure covered entities and business associates are complying with HIPAA privacy and security standards. Audits first began in November of 2011 and will continue through December of 2012. A sample notification letter and details on what to expect if you are chosen for audit is available on the HHS website.

Accordingly, now is the perfect time to ensure that:

• Policies, procedures, and documentation comprehensively address all privacy and security requirements;
• Privacy and security training has been completed and documented;
• Actions (complaints addressed, investigations performed, implemented mitigation plans) taken to maintain compliance with HIPAA and develop privacy and security protocols have been documented; and
• Your security risk assessment and documentation of your risk management decision-making process are up to date.

The following resources are available on the HHS website to assist you in maintaining compliance with HIPAA’s complex privacy and security laws:

• The Privacy Rule,
• The Security Rule, and Security 101 for Covered Entities,
• The Breach Notification Rule.

**Update** January 25^th, 2012:  The CBIC has posted a Q&A concerning the credit score requirement for the competitive bidding process.  The update confirms that if you have not requested your score there is still time to complete this task even after the bid window opens and up until the time of bid submission.  The only results that will be invalidated are scores that were obtained more than 3 months ago.  The official cut-off deadline can only be published after the bid window opens and they can subtract 90 days from that date.  (For example: right now the window is expected to open on January 30, and if that is the case, then the CBIC will only accept scores printed no earlier than 90 days from that date which would be November 1, 2011).  But for most providers we just wanted to be sure that we can get our scores printed all the way up through the day we submit our bids, and that appears to be the case.

**UPDATE** We are expecting CBIC to post an FAQ to address the credit report deadline and based on intial conversations credit scores are expected to be considered timely as long as they are dated 90 days prior to bid submission. Please stay tuned for updates.

If you are planning on submitting a bid for Round 2, there are two major deadlines that you need to meet in order to secure your ability to participate in the bid submission process.  First, you must get a copy of the official business credit score printed within the last 90 days but no later than 01/29/2012.  Second, hopefully your bid registration of your authorized official, backup authorized official and end users is already complete; but if not, the registration window is also coming to a close on 02/09/2012.

Here is the information relevant to the credit score requirement as published on the CBIC website:

Credit report with numerical credit score
Suppliers must submit a copy of a credit report with numerical score that was prepared within 90 days prior to the opening of the bid window.

Credit reports must be prepared by one of the following: Dun & Bradstreet, Experian, Equifax, TransUnion, or Standard & Poor’s. Credit reports from other companies will not be accepted.

Credit reports must include a numerical score. The only exception is an alpha score from Standard & Poor’s. Any other forms of gauging credit other than a numerical score (such as arrows indicating relative value of credit or the number of days beyond term) are not acceptable. 

If no credit report is available for the business, a personal credit report and numeric score for the principal business owner is acceptable as long as it is prepared by an acceptable bureau within 90 days prior to the opening of the bid window. However, a personal credit report and score is not acceptable from bidders filing a regular ‘C’ corporation tax return (Form 1120), except in cases of newly-formed corporations.

DME consultant Andrea Stark will be holding a live reimbursement workshop in Columbia, SC, THIS FRIDAY on January 20, 2012 to teach suppliers how to improve efficiency, effectiveness and production in their billing departments. 

The Building DME Competence and Confidence Workshop will be held at the Columbia/Lexington Wingate Inn from 8:30am to 3:30pm. Registration is required to attend.

Topics to be discussed during the workshop include:

• The Secrets of a Self-Sufficient DME Supplier
• The Building Blocks of Medicare Reimbursement
  • Reimbursement Fundamentals Part 1: Medicare Documentation
  • Reimbursement Fundamentals Part 2: General Coverage Criteria
• Understanding the Lifecycle of a Claim (It May Be More Complicated Than You Think!)
• Fine Tuning Your Billing Machine
• How to Make Your Billing and Operations MORE Operational

Click here for a detailed agenda with hotel information.

SECURE YOUR SEAT TODAY!

Registration closes on Thursday, January 19th at 12pm EST. Lunch and workshop materials are included in the registration fee.

Deductible season is upon us. In January a new deductible benefit period will begin for most insurance providers and patients will again have to meet their annual deductibles.  For 2012 the Medicare deductible is dropping from $162 to $140. It is the first time a Medicare deductible has dropped in over 20 years.

Suppliers can expect deductible season to impact payment posting and AR, as more time will be involved in passing charges to the patient and forwarding balances to secondary insurances. Suppliers should be proactive in utilizing real-time eligibility to determine a patient’s unmet deductible. It’s also important to notify rental patients in advance that they will have to pay the deductible along with their 20% co-insurance.

Monthly premiums (which is the dollar amount paid monthly to secure Part B benefits), will also see a decrease. The 2011 base premium was set to $115.40/month, and that base will decrease to $99.90/month. Additionally those receiving Social Security benefits will actually see a 3% increase in their benefits this year.

CMS has fulfilled their promise to publish a list of providers and suppliers who were sent revalidation requests.

As you may be aware, the Affordable Care Act (ACA) requires all suppliers and providers who enrolled in Medicare prior to March 25, 2011 to undergo a new process known as revalidation. As part of revalidation, suppliers must:

• Submit a re-enrollment application (but not until requested to do so by the NSC),
• Pay an application fee, and
• Pass a series of enhanced screenings, background checks, and on-site visits designed to weed out illegitimate providers.

[For full details on what to expect during revalidation and how to submit your application, download the Are You Ready for Revalidation? Parts 1 and 2 digital recordings on our products page.]

While suppliers should not wait to submit important change of information updates to the NSC, such as a change in the types of products supplied or the opening of a new location, you must wait until you have been contacted by the NSC to submit a formal revalidation package (either via PECOS or a paper CMS-855S). Initially, CMS gave contractors until March 23, 2013 to send revalidation request letters to all currently enrolled suppliers and providers. However, after performing an assessment of the task at hand, CMS has extended that timeline to March 23, 2015.

The extended timeline does not necessarily mean your revalidation letter will be delayed, nor does it give suppliers who have already received one an extended response time! Letters are actively being sent to suppliers and providers as you read this. Upon receiving a request for revalidation you have only 60 days to submit an application before your billing privileges are revoked for non-response. If you have yet to receive your letter, we recommend you start preparing early by ensuring your business, county and state licenses are up to date. It is also a good idea to proactively register for access to the PECOS system (this process can take several weeks), which will allow you to see exactly what information the NSC has in your file and ensure that any necessary changes are submitted before revalidation catches you unprepared.

So how do you know if you’ve been sent a revalidation request letter? As mentioned at the top of this article, CMS has released a list of those suppliers and providers that have been sent revalidation requests through October 17, 2011. The list is available at: https://www.cms.gov/MedicareProviderSupEnroll/11_Revalidations.asp.

The list contains the names and NPIs of each supplier sent a request, and the date the letter was sent. It will download in a CSV format that may be opened using Microsoft Excel or other database programs. CMS plans to update the list on a monthly basis.  Suppliers who find their names on the list but who have not yet received their revalidation request letter should contact the NSC directly at 866-238-9652.

You may also use the link above to download a sample revalidation letter and get an idea of what to expect. While not yet final, CMS is considering sending out revalidation letters in an uniquely colored envelope to flag providers’ attention to this important request.

The January 1, 2012 deadline for a mandatory transition to the new HIPPA X12 version 5010 is fast approaching! In just two short months, CEDI will reject 837 and NCPDP (pharmacy drug) claims that are not submitted using 5010 standards.

Prior to the start of next year, your clearinghouses and software vendors will need to successfully complete testing with National Government Services, the CEDI contractor, and become approved to transmit claims in the new 5010 format. To find out whether your vendor is currently approved to transmit your Medicare claims in 5010, visit http://www.ngscedi.com/outreach_materials/outreachindex.htm and look for the “5010/D.0 Approved Entities List” (last updated 11/01/11).

If your vendor has not yet completed testing with CEDI, you may wish to let them know about a special teleconference the contractor will be holding on November 9, 2011 to help software vendors and clearinghouses work though any issues that may be preventing  them from successfully making the transition. Registration information is available here.

All current systems used to submit claims, receive electronic remittances and exchange claim status inquiries will be affected by the switch to the new 5010 standards. When talking with your vendor, be sure to find out:

1. When your system will be upgraded,
2. If you will be charged for the upgrade, and
3. Whether you will be required to buy any new hardware or software.

If you currently use PC-ACE Pro32 or Medicare Remit Easy Print (MERP) software to transmit your claims and receive EOBs, both software systems will be able to support 5010.

DME consultant and reimbursement expert Andrea  Stark will be travelling  across the nation to bring a special educational workshop to DME suppliers. Each full-day event will focus on helping suppliers “learn to fish for themselves” by promoting confidence in essential reimbursement concepts and improving competence in Medicare billing processes and procedures.

For detailed information on topics, dates and cities, visit our Seminars/Webinars page.

Can’t see the video below? Click this link! (Plays on Windows Media Player)

Andrea and Derrick Stark will be presenting several sessions at Medtrade in Atlanta, GA on October 24-26, 2011 and would love the opportunity to speak with you in person!

For detailed information on their course offerings, watch the video above, then visit: http://www.medtrade.com/medtrade/conference/conference-schedule. 

Search by speaker and add their events to your current registration!