Medicare suppliers must recertify their CEDI Trading Partner ID annually. Failure to do so results in deactivated billing privileges. To avoid cash flow disruptions and sleepless nights, take a minute now to be sure your company has already completed the process.

To complete the online recertification, suppliers need the following information:

1. CEDI Trading Partner ID (a nine-digit number that usually begins with B08, C08, D08, or A08).
2. Provider name.
3. Type of trading partner (direct submitter (of your own claims), billing service, or clearinghouse). 
4. Primary address (street, city, state, and zip code).
5. Telephone number.
6. NPI (any one linked to the account, but only use one (even if you have multiple)).
7. PTAN (any one linked to the account, but only use one (even if you have multiple)).
8. Primary authorized contact responsible for all activity (name, phone, and email).
9. Up to nine additional authorized contacts (name, phone, and email).

​Immediately after submission, the CEDI contractor sends the primary authorized contact a confirmation email with a tracking number and the subject line “CEDI Recertification Form 2020.” 

CEDI usually completes the recertification process within one to two business days. The process is complete when the primary authorized contact receives the confirmation email from cedienrollment@anthem.com with the subject “2020 Recertification Form Accepted.” 

Suppliers can contact the CEDI Help Desk at 866-311-9184 to ask questions or inquire about recertification status.

SOURCE LINKS
https://enroll.ngscedi.com/recertification
https://www.ngscedi.com/ngs/portal/ngscedi?1dmy&urile=wcm%3apath%3a/ngscedicontent/home/news+and+events/news/2020+CEDI+Trading+Partner+Recertification+Process

In the DME Proposed Rule CMS-1738-P released last month, CMS proposes a significant expansion of continuous glucose meter (CGM) coverage with two new classes of CGMs and fixed monthly payments for related supplies. The rule does not alter device pricing; it only addresses payment amounts for monthly supplies.

The proposal comes on the heels on legal actions challenging CMS’s limitation of coverage to those CGMs cleared by the FDA to fully replace glucometers. If finalized, CMS suggests changes take effect on April 1, 2021.

CMS-1738-P proposes the following CGM classifications and supply allowances:
​

• Non-Adjunctive and Automatic.
• Non-Adjunctive and Manual.
• Adjunctive and Automatic.

Non-Adjunctive and Automatic

For those not already familiar with the term, adjunctive is an adjective to describe something that is “added to something else as a supplement rather than an essential part.” In this case, it describes the CGMs relationship to a blood glucose monitor. Non-adjunctive means the FDA has approved the CGM for use in making diabetes treatment decisions without a separate fingerstick.

​Furthermore, this category of devices automatically checks glucose levels and sends patients alerts when levels are too high or too low.

Medicare currently covers these devices. Since Medicare does not have to reimburse for traditional glucometer supplies, the monthly supply allowance remains unchanged:

• $259.20 if used with a Class III device (e.g. Dexcom G5).
• $222.77 if used with a Class II device (e.g. Dexcom G6).

Non-Adjunctive and Manual

CGM devices categorized as non-adjunctive and manual also have FDA approval for accuracy, but they do not automatically transmit readings to the receiver or alert the patient of dangerous glucose readings until the patient manually checks their device. These devices are frequently used for overnight monitoring of glucose levels.

Based on readily available supplier pricing, CMS proposes the following monthly fee for disposable batteries and sensors used with non-adjunctive, manual CGMs:

• $52.01 if used with a Class III device (e.g. Freestyle Libre 1).
• $46.86 if used with a Class II device (e.g. Freestyle Libre 2).

Adjunctive and Automatic

Adjunctive devices do not have FDA approval to fully replace traditional glucometers, so Medicare will still have to pay for traditional glucometer supplies. As such, the monthly CGM supply allowance reflects a $34.35 payment reduction to permit separate billing of a glucometer and testing supplies. CMS proposes the following monthly fee for supplies used with these CGMs:

• $198.77 if used with a Class III device (e.g. Medtronic Minimed 770G).
• $172.62 if used with a Class II device.

CMS may expand HCPCS for both the devices and the supplies, although the agency could direct contractors to utilize modifiers or claim narratives to differentiate between the types of supplies.

​Interested parties can submit comments on any part of the proposal through January 4, 2021.

SOURCE LINKS
https://www.govinfo.gov/content/pkg/FR-2020-11-04/pdf/2020-24194.pdf
https://www.regulations.gov/comment?D=CMS-2020-0128-0001

Insurance companies are blanketing the airwaves with commercials enticing Medicare beneficiaries to leave fee-for-service coverage for Medicare Advantage plans in 2021. They promise to save money and offer additional benefits like gym memberships, transportation, and coverage for drugs, dentists, hearing aids, and more.

But, it’s not sunshine and daisies for everyone …

​Unanticipated insurance changes disrupt cash flow. Plan switching in-between resupply intervals or during active rentals is particularly difficult for HME suppliers. Fortunately, proactive organizations need not wait for a denial to take action and preserve the revenue cycle.

​Suppliers can Identify Medicare Patients Changing to Advantage Plans Before the Switch!

Suppliers can use Medicare eligibility tools available in the myCGS and Noridian Medicare Portals, as well as many billing software applications, to determine which Medicare patients are changing to Medicare Advantage before the switch occurs! By entering a future date of service for the check, the eligibility search will return the insurance details effective next year.

By checking 2021 eligibility in December for Medicare patients, especially those with recurring rentals that may not have direct interaction with staff, suppliers can proactively secure the medical documentation necessary to continue the billing cycle. Waiting until the inevitable January denial is certain to depress cash flows and increase strain on the billing department.

Engage Patients Directly

Every patient interaction from now until January is an opportunity to identify insurance changes and preserve cash flows with less effort. With every patient call, customer service personnel should consistently perform a future eligibility check and ask about changes to insurance coverage.

Moreover, suppliers can include colored flyers with patient statements to notify customers of the need to alert the billing department of any upcoming insurance policy changes. Use the opportunity to remind customers that new insurance may require:

• Prior authorization.
• Retesting.
• Office visits.
• A supplier change (when the current DME provider is not in network with the new insurance company). 

Evaluate Plans and Negotiate Enrollment

Suppliers should also evaluate new and existing plans in which they participate. Plan offerings change; those with previously closed networks may once again accept new providers. However, suppliers must have a clear understanding of the fit and fitness of a plan before agreeing to participate. Above all, efficient organizations must actively educate employees and customers on which local plans they accept. Planning and clarity allow suppliers to keep the patients they can and help the others with unsustainable coverage move on.

To start, suppliers can use the Medicare find-a-plan website to take stock of which Advantage plans operate within their service area. To use the tool:

• Navigate to the find-a-plan website.
• Click [Continue without logging in].
• What type of coverage are you looking for? Click [Medicare Advantage Plan].
• Enter your five-digit zip code.
• Click [Select Your Location].
• Do you get help with your costs from one of these programs? Click [I’m not sure].
• Click [Continue without logging in].
• Do you want to see drug costs? Click [No].
• Click [Next] to view plans. 

New Benefit may Yield Higher-Than-Usual Volume in Insurance Changes

This year, a new Part D and Medicare Advantage benefit is likely to increase the number of patients changing insurance. Hundreds of plans permit diabetic patients to pay a flat $35/month co-pay for insulin, regardless of unmet deductibles or phase of coverage. CMS advertises the benefit will save the average senior $446 annually.

Because the cash flow disruption could be worse than usual, suppliers have one more reason to proactively verify eligibility for Medicare customers before the end of the year. Carve out dedicated time now to communicate with patients, perform eligibility checks, and follow through with necessary insurance coordination between the patient, doctor, and insurance carrier. Doing so will prevent unnecessary denials and decreased profits.

SOURCE LINKS
https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Medicare-Open-Enrollment-Print-Ad.pdf  
https://www.cms.gov/files/document/insulin-costs-beneficiaries-infographic.pdf
https://www.cms.gov/newsroom/press-releases/cms-launches-groundbreaking-model-lower-out-pocket-expenses-insulin
https://www.cms.gov/files/document/insulin-common-questions.pdf
https://www.medicare.gov/find-a-plan/questions/home.aspx
​

With the passage of H.R. 8337 in October, Congress generously modified repayment terms for loans made to suppliers earlier this year through the Advance and Accelerated Payments program. The law establishes a grace period deferring repayment for one year from the original loan date and provides for a longer offset repayment period thereafter.

During the early days of the pandemic, amidst a backdrop of uncertainty, CMS advanced DME suppliers up to three months’ worth of routine Medicare payments. The MACs originally planned to recover advances after 90 days through an offset of 100% of the borrowing supplier’s Medicare payments. The new law offers suppliers significantly more time to repay the debt.

Revised Repayment Schedule

During the initial 12-month grace period, suppliers make no payments toward their loan balance and accrue no interest. When the grace period ends, Medicare will offset 25% of Medicare payments and divert the recovered funds toward loan repayment. The 25% continues for 11 months or until the loan balance reaches zero, whichever is first.

If the 25% offsets do not satisfy the loan balance, Medicare will increase the offset amount to 50% for up to six more months.

Demand Letters

For loans not fully repaid within 29 months of the loan date, Medicare will send demand letters requesting payment-in-full of any remaining balance. Suppliers have 30 days from the date of the letter to comply. If the supplier fails to pay the loan in full, CMS will assess a 4% penalty on the residual balance every 30 days while the loan carries a balance.

Extended Repayment Schedules

CMS does not have the authority to stop automatic offset activity or reduce the offset percentage because the repayment terms are established by law. However, suppliers who cannot pay the remaining loan balance in full within 30 days of the demand letter date due to a documentable financial hardship can apply for an Extended Repayment Schedule (ERS). Suppliers in Jurisdictions B and C should visit the CGS ERS Resource page at https://cgsmedicare.com/ers/index.html. Suppliers in Jurisdiction A and D can find Noridian resources here and here, respectively.

Pre-Payments

Suppliers can submit one or more lump sum payments to avoid or lessen the impact of offsets. Those interested should contact the applicable DME MAC’s customer service department for specific instructions.

Given the extended nature of the revised repayment schedule, suppliers who accepted these loans can worry less about the immediate effects of offset payments. Nonetheless, these funds are temporary loans, and suppliers must plan for their eventual repayment. 

SOURCE LINKS
https://www.congress.gov/116/bills/hr8337/BILLS-116hr8337enr.pdf   
https://www.cgsmedicare.com/articles/cope19171.html
https://www.cms.gov/files/document/covid-advance-accelerated-payment-faqs.pdf