(See: http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844LJ42683?opendocument)

On March 23, 2010, President Obama signed into law a new healthcare bill, the Patient Protection and Affordable Care Act (H.R. 3590). There are multiple provisions within the bill that impact DME. One of these provisions is a reduction in the amount of time suppliers have to file a Medicare claim.

Effective for services performed on or after January 1, 2010, suppliers will have just 12 months to file a claim after the date of service. In addition, claims for services performed prior to December 31, 2009 must be submitted no later than December 31, 2010 (Medicare will currently accept claims back through October 1, 2008).

This means that suppliers will have to get all of their Medicare claims from 10/1/2008 (current timely filing) through 12/31/09 filed by Dec 31st of this year. That leaves less than 8 months to get these claims in before they fall off the grid! Suppliers must also look forward to services performed in January 2010 and anticipate their upcoming expiration.

While these provisions are in effect immediately, it is expected that the Secretary will make certain exceptions to the new one-year filing deadline in future proposed rules. However, do not expect many saving graces.

Full details on how the new healthcare bill impacts DME are included in the  April issue of Vista Notes. To become a subscriber and recieve an immediate downlaod of the April issue, click here or visit our Products page.

Andrea Stark will also be hosting a special webinar to answer supplier questions on how various provisions in H.R. 3590 impact the DME industry. 

• Will you have to provide DME at Competitive Bid prices?
• Will pharmacies be able to stay in the game without accreditation?
• Are there new face-to-face visit requirements for DME?
• Is Medicare going to make you pay an application or re-enrollment fee?
• Will you have to rent your power wheelchairs? 

…To get the answers to these questions and more, register to attend The Impact of H.R. 3590 on DME: How the new Healthcare Bill Affects You! webinar, on May 5, 2010 @ 2:00pm EST. Click here to register, or visit our Seminars/Webinars page. Digital recordings are also available for purchase.

DME suppliers who did not meet surety bond or accreditation deadlines were advised to voluntarily terminate their billing numbers to prevent being suspended from the Medicare program for a period of one year. Those suppliers who submitted a voluntary termination request did so with the understanding that billing privileges would be reinstated once they met all Medicare billing requirements and billing would be retroactive to the date of accreditation.

However, CMS recently threw a serious monkey wrench into the mix when they stated that suppliers would NOT in fact be able to bill retroactive to their date of accreditation, as previously thought. Instead, suppliers must now wait until their CMS-855S applications have been processed by the NSC to begin billing Medicare and will only be able to bill for services performed on or after the date their number is reactivated.

Several organizations, including AAHomecare, MAMES and the NSCAC are working towards a reversal of this policy. You can count on MiraVista to keep you posted on any changes.

H.R. 3363 is a bill to effectively delay the accreditation deadline for pharmacies who supply DME until January 1, 2010. The bill was introduced to the House on 9/29/09 and quickly passed with a voice vote on 9/30/09. On 10/01/2009 the bill was received by the Senate and was subsequently passed on October 5, 2009.

Update: On October 7, 2009, the bill was presented to the President for signature. As of October 12, 2009 the bill has not yet been signed into law.

While the bill seeks to delay the accreditation deadline for most pharmacies, those that wish to participate in the Competitive Bidding program will still need to meet Medicare’s accreditation requirement prior to placing their bids. Also, the bill only applies to organizations registered with the NSC as a pharmacy dispensing DMEPOS and not DMEPOS providers in general (even if they have a pharmacist on staff).

On 10/05/09, an HME News article reported that CMS is allowing pharmacies who have requested a voluntarily termination of their billing numbers or who have submitted an amended CMS-855S indicating they will no longer provide DME to continue billing Medicare, so long as the NSC has not already processed their application. Per the article, CMS has also asked the NSC to stop processing any further pharmacy applications for voluntary termination.

The article, entitled “House delays accreditation requirement for pharmacies” may be read in its entirety here.

MiraVista sent an inquiry to both CMS and the NSC requesting verification of these statements and further clarification. As of this posting, we have received no response.

Update: On October 09, 2009, the NSC released instruction to the DME MACs regarding H.R. 3363 and those pharmacies that submitted a voluntary termination prior to the original October 1 deadline. Bulleted points from the instruction have been copied and pasted below. To read the instruction in its entirety, click here.

• Pharmacies that were not accredited prior to the October deadline are not subject to the revocation of Medicare billing privileges at this time.
• Any pharmacies that submitted a voluntary termination that now wish to withdraw this request, must submit a letter to the NSC signed by the authorized official.
• The letter MUST be received by the NSC no later than October 23, 2009.
• Letters may be faxed to the NSC by geographic location.

The NSC included a map in its instruction to help pharmacies determine the appropriate fax number for their location. A copy of that map has been posted below:

© National Supplier Clearinghouse, 10/09/2009

National Supplier Clearinghouse Jurisdiction Map

 

Pharmacies on the East coast (Red) should fax termination withdrawal letters to: 803.382.2405.

Pharmacies in the Central region (Yellow) should fax termination withdrawal letters to: 803.382.2408.

Pharmacies on the West coast (Blue) should fax termination withdrawal letters to: 803.382.2406.

To read the full text of H.R. 3363, as well as track its progress, please visit this link:

http://www.washingtonwatch.com/bills/show/111_HR_3663.html#toc0.

Updates will be posted as they become available.

With the Accreditation and Surety Bond deadlines upon us, the NSC is receiving a heavy influx of calls from anxious providers wanting to check on the status of their applications. As a result, providers calling the NSC are finding themselves greeted not by a friendly customer service rep, but a continuous busy signal on the other end of the line.

To beat the busy signal, providers with questions on accreditation and surety bond requirements should try to find answers utilizing the NSC’s FAQ page or Accreditation and Surety Bond Exemptions chart.

For those checking on the status of their applications, the NSC is asking providers to allow their system at least two weeks to show mailed documents as received, prior to calling the customer service line.

Currently, the NSC has stated that it will not revoke the billing privileges of providers for which it has received accreditation information from their Accrediting Organization and a copy of their surety bond.

For more information, see MiraVista’s Important Accreditation Updates! news article below.

(See: http://www.nscac.sitecreatorplus.com/f/nscac_august_2009_q&a_revisedfinal.doc)

Exactly 29,698 suppliers remain unaccredited as of August 24, 2009, according to a recent FAQ released by the National Supplier Clearinghouse Advisory Committee (NSCAC).

If you’re one of those nearly thirty-thousand, you’ve no doubt heard of CMS’ request for all suppliers who will remain unaccredited by the September 30^th deadline to voluntarily terminate their billing numbers by 10/01/2009. Whether you’ve decided not to partake in accreditation at this time or are in the midst of the accreditation process, voluntarily terminating your billing privileges will prevent you from being barred from the Medicare program for a period of 1-year and allow you to re-enroll once all Medicare billing requirements have been met (accreditation, surety bond, etc.). 

What happens if you voluntarily terminate your billing number?

Claims Processing:

Per the NSCAC, as long as a claim’s date of service is before the effective date of termination for your billing number the claim will still be processed. However, any claims submitted after the effective date of termination will not be paid and billing is not retroactive upon re-enrollment.

Patient Services:

Suppliers who voluntarily terminate their billing privileges must notify patients that they will no longer be participating in the Medicare program. The NSC has provided a sample letter to send to patients, which may be downloaded here.

Re-enrollment:

If you voluntarily terminate your billing number and opt to re-enroll at a later date, you will need to submit a CMS-855S.  Billing privileges will resume effective the date of compliance with both surety bond and accreditation requirements. 

What if you’re bonded/accredited and waiting on the NSC to update your status?

Initially, providers were asked to submit a CMS-855S to notify the NSC of their accreditation status. However, due to time constraints the NSC began allowing accrediting organizations to directly inform them of a provider’s accreditation.

Understandably, the NSC has become back-logged and there is concern among providers who have submitted an updated CMS-855S that their form will not be processed by 10/01/09. If you have this concern, you should contact your accrediting organization and request they directly notify the NSC of your accreditation status. At this time, the NSC has stated that it will not revoke the billing privileges of providers for which it has received a surety bond or information from their accrediting organization.

By: Michelle Duncan

Effective 02/02/09, the National Supplier Clearinghouse Medicare Administration Contractor (NSC-MAC) will begin performing fraud analyses of all current DMEPOS suppliers, initial applicants and  Medicare re-enrollment applicants.

DMEPOS suppliers will be assigned one of four fraud and abuse risk levels, ranging from low risk to high risk. The NSC-MAC will take the following seven factors into consideration, along with information from the OIG, CMS and/or a PSC when accessing a supplier’s risk level:

1. Experience as a DMEPOS supplier with other payers
2. Prior Medicare experience
3. Geographic location
4. Fraud potential of products and services provided
5. Site visit results
6. Inventory
7. Accreditation of the supplier

Review plans will be established for DMEPOS suppliers based on their risk levels and may include a set number of unscheduled site visits and/or maximum billing quotas a supplier must meet.

A supplier’s risk level will be updated on a yearly bases. Please click here for complete details from CMS (Chapter 10 of the Medicare Program Integrity Maunal).

By: Andrea Stark & Michelle Duncan

If you haven’t applied for accreditation, you’ll want to do so…and soon! According to CMS, suppliers need to apply for accreditation by January 31, 2009, in order to meet the September 30, 2009 accreditation deadline. Suppliers who haven’t applied by January 31^st risk missing the accreditation deadline and losing their Medicare supplier number.

During the accreditation process, it typically takes 4-6 months to prepare and collect data. The requirement applies to all DME suppliers, as well as pharmacies and breast care fitters.

A list of Medicare approved accrediting bodies can be found in the Accreditation Specialists section of MiraVista’s Industry Links.