DMERC News by Datalogic Software

Medicare to Stop Mailing Standard Paper Remittance (SPR) for Those Providers/Suppliers Also Receiving the Electronic Remittance Advice (ERA) Beginning June 1, 2006 Alternative

Payment Provisions in the Original Medicare Program Immediately Affected by the Deficit Reduction Act

Guidelines for DMERC Reconsiderations

Medicare System Edits for Respiratory Assist Devices (RADs) with Bi-Level Capability and a Back-Up Rate

Proper Billing of Zero-Pressure Tire Tube Inserts K0093 and K0097

Surrogate UPIN's http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM4177.pdf

DME MAC Information More...

New DME MAC's Regions

NUCC Approves a Revised 1500 Health Insurance Claim Form

Electronic Claim Submission for Break in Service Claims

Medlearn Matters: New Coding Changes

Medlearn Matters: Evidence of Medical Necessity: Electric Wheelchairs and POV's

Wheelchair Changes - CMN

Change of Address Requests Due to Hurricane Katrina

Capped Rental Equipment Lost or Damaged in Hurricane Katrina

New Power Mobility Device Codes

DL21322 - Power Mobility Devices

October 2005 Quarterly Fee Schedule Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

New Regulation on Power Mobility

Decision Memorandum
National Coverage Determination
Mobility Assistive Equipment Algorithm
Interagency Wheelchair Work Group (IWWG) Recommendation
Power Mobility Device Regulation
Power Mobility Device Regulation Fact Sheet
Power Mobility Device Regulation Qs & As

Top 10 Denial Codes and Reasons

Medicare Announces End of HIPAA Contingency Plan for Claims Submissions

Urge Congressional Support for Hobson-Tanner Bill

Implementing a New Medicare Claims Appeals Process

CMS ENDING CONTINGENCY FOR NON-HIPAA- COMPLIANT MEDICARE CLAIMS

Remittance Advice Remark Code and Claim Adjustment Reason Code Update for DMERC

Update to the Place of Service (POS) Code Set to Add a Code for Pharmacy for DMERC

FAQs: Mobility Assistive Equipment (MAE)

Power Operated Vehicles - Policy Clarification

Region B Online Payment Tool

Non-Physician Practitioner Questions and Answers Revised: 6/14/2005

Power Wheelchairs - New

New Healthcare Common Procedure Coding System (HCPCS) Drug Codes

EYE.0705 - Eye Prosthesis, Summer 2005 Revision

AED.0705 - Automatic External Defibrillators LCD, Summer 2005 Revision

IMNO.0705 - Immunosuppressive Drugs, Summer 2005 Revision

Replacement Chart - Summer 2005 Region C DMERC DMEPOS Supplier Manual Revisions

LENS.0705 - Refractive Lenses LCD, Summer 2005 Revision

DS&E.0705 - Home Dialysis Supplies and Equipment, Summer 2005 Revision

SGD.0705 - Speech Generating Devices, Summer 2005 Revision

Region C DMERC DMEPOS Supplier Manual (updated through Summer 2005)

DMERC Information Form (DIF) Reinstated

NPI - Registration and Information

Lymphedema Compression Devices

2005 Region C DMERC, Second Quarter Fee Revisions

National Provider Identifier (NPI): Enumeration Begins May 23, 2005 for DMERC

CMS Announces the National Provider Identifier (NPI) Enumerator Contractor and Information on Obtaining NPIs for DMERC

MMA - Supply Codes and Payments for Immunosuppressive Drugs for DMERC

ABN - News

2005 Fee Schedule Amounts for Oxygen and Oxygen Equipment - Corrections

NSC News - April 2005

New HCPCS Codes for Intravenous Immune Globulin (IVIG) for DMERC

2005 Oxygen Fee Schedule Update

Medicare Announces Delay in Processing Certain Claims No Later Than April 18, 2005 for DMERC

Region C DMERC DMEPOS Supplier Manual (updated through Spring 2005)

Claims Status Code/Claims Status Category Code Update

EIP.0405 - External Infusion Pumps, Spring 2005 Revision
This DMERC REGION C LCD was revised to include new and revised HCPCS Codes, added intravenous use for treprostinil.
OCAN.0405 - Oral Anticancer Drugs, Spring 2005 Revision
This DMERC REGION C, LCD for Oral Anticancer Drugs was revised to add HCPCS code G0370, remove NDC numbers and to add a statement about the denial of supply fees.
FACE.0405 - Facial Prostheses, Spring 2005 Revision
This DMERC REGION C LCD was revised to add HCPCS Code A5119.
OEMT.0405 - Oral Antiemetic Drugs, Spring 2005 Revision
This DMERC Region C, LCD Oral Antiemetic Drugs was revised to add G0370 and J8501 HCPCS codes.
CTD.0405 - Cervical Traction Devices, Spring 2005 Revision
This DMERC REGION C LCD was revised to add new HCPCS CODE E0869 from K0627. Code was effective 01/01/2005.
OSTY.0405 - Ostomy Supplies, Spring 2005 Revision
This DMERC Region C, LCD Ostomy Supplies, was revised due to the verbiage revision of HCPCS code A5119, to add ICD-9 code for coverage, and to delete the need for the ICD-9 code or narrative to be present on the order.
HFCW.0405 - High Frequency Chest Wall Oscillation Devices, Spring 2005
This DMERC REGION C LCD has been revised to allow conventional CT scan for diagnosis of bronchiectasis.
SUCP.0405 - Suction Pumps, Spring 2005 Revision
This DMERC REGION C LCD Suction Pumps was revised to add new HCPCS code A4605 and delete HCPCs code A4609, A4610.
ENT.0405 - Enteral Nutrition, Spring 2005 Revision
This DMERC Region C LCD has been revised to include new, deleted and revised HCPCS Codes; replaced references to Category IV and V with corresponding HCPCS Codes in Documentation Section.
URO.0405 - Urological Supplies, Spring 2005 Revision
This DMERC Region C LCD Urological Supplies was revise due to adding, deleting and revising verbiage of HCPCS codes.
LLP.0405 - Lower Limb Protheses, Spring 2005 Revision
This DMERC Region C LCD Lower Limb Prostheses has been revised to add new and discontinue HCPCS Codes. Added L5679 and deleted code L5671 from socket insert utilization guideline.

WCA.0405 - Manual Wheelchair Base, Spring 2005 Revision
This DMERC Region C LCD was revised to add new HCPCS Code E1229, and to revise the documentation requirements for K0005. This LMRP was converted to an LCD and Policy Article.
WCC.0405 - Wheelchair Options/Accessories, Spring 2005 Revision
This DMERC Region C LCD was revised in include new KC modifier, new, revised and discontinued HCPCS codes. Included specific documentation necessary when billing K0108 for nonstandard power wheelchair seat dimensions or when billing E2399.
SURG.0105 - Surgical Dressings LCD, Winter 2004 Revision
This DMERC Region C LCD was converted to an LCD and Policy Article from an LMRP.
WCS.0405 - Wheelchair Seating LCD, Spring 2005 Revision
This DMERC Region C LCD was revised to add new HCPCS codes (E2291-E2294).
WCB.0405 - Motorized/Power Wheelchair Base, Spring 2005 Revision
This DMERC Region C LCD was revised to add new HCPCS Codes E2291-E2294.

The Facts for Providers Regarding the Medicare Prescription Drug Plans That Will Become Available in 2006

New Front End Edits for DMERC EDI Submitters beginning March 3, 2005

OSTY.0405 - Ostomy Supplies, Spring 2005 Revision

C: Replacement Chart - Spring 2005 Region C DMERC DMEPOS Supplier Manual Revisions

C: Elimination of Paper Remittance Notices

C: Examples of correct billing units for J7616 (Duoneb)

C: Modifications to Duplicate Editing for Dispensing/Supply Fee Codes for Oral Anti-Cancer, Oral Anti-Emetic, Immunosuppressive, and Inhalation Drugs

C: 2005 Region C Drug Fee Update, revised

D: April 2005 Quarterly Fee Schedule Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

C: Prosthetics and Orthotics Ordered in a Hospital or Home Prior to a SNF Admission for DMERC

C: CMS Consolidation of the Claims Crossover Process for DMERC

C: April 2005 Quarterly Fee Schedule Update for DMEPOS

C: Administrative Simplification Compliance Act (ASCA) Enforcement of Mandatory Electronic Submission of Medicare Claims for DMERC

C: Top DMERC Denial Reasons and Telephone Inquiry Topics, October - December 2004

C: The Facts To Know when Billing Acetylcsteine (J7608) and Terbutaline (J7680)

C: Issue 51, Winter 2004 DMERC Medicare Advisory

C: Suppliers, Did You Know? Facts about Diabetic Shoes

ALL: Billing of Enteral Nutrition Products - New HCPCS

C: Nonstandard Seat Frame Dimensions – Power Wheelchairs

C: 2005 Region C Drug Fee Update

C: 2005 First Quarter Oral Anti-Cancer Drug Fees

C: Correction to Individually Considered (IC) Chart Included in Winter 2004 Publications CD-ROM Fee Schedule Update

C: Joysticks, Controllers and Replacements

C: FAQs from Your Ombudsmen: Tracheostomy Care Supplies

B: Fraud Alert

C: 2005 Payment Amounts for Oxygen and Oxygen Equipment

ALL: Online Tutorials Available for DMEPOS Suppliers

D: Paid by Average Selling Price Beginning January 1, 2005 (PDF document - 270K)

ALL: Guidance Regarding Elimination of Standard Paper Remittance (SPR) Advice Notices in the Old Format for DMERC, revised

ALL: Advance Determination of Medicare Coverage and Wheelchair Seating Policy

B: MCS conversion problems affected some Electronic Remittance Advices (ERAs) - Due to a problem converting providers to MCS, some electronic submitters have not received Electronic Remittances Advices (ERAs) since November 24, 2004. If you normally receive Electronic Remittance Advices (ERAs) and have not received any since November 24th, your provider number was affected during this conversion. These ERAs will not be regenerated electronically to download. Providers affected will receive a paper Explanation of Medicare Benefits (EOMBs) through the mail. Once the problem is corrected, a follow-up notification will be sent via the EDI listserve.If you have NOT received your ERA file, all remittance advices generated since November 24th will be received through the mail in the paper format.

B: HIPAA News http://list.nih.gov/archives/hipaa-outreach-l.html

C: MMA - Drug Administration Coding Changes and Reimbursement for DMERC

B: Region B DMERC Revised Medical Policies

B: Inappropriate Access to or Use of Electronic Data Interchange (EDI) Transaction Data by Third Party Entities

D: DMERC Region D Supplier Manual update

D: Winter 2005 Region D DMERC Dialogue

C: Region C DMEPOS Supplier Manual (updated through Winter 2004)

C: Replacement Chart - Winter 2004 Region C DMERC DMEPOS Supplier Manual Revisions

C: 2004 Fee Schedule Amounts For Wheelchair Seat and Back Cushions

C: MMA - Drugs Paid by Average Selling Price Beginning January 1, 2005 for DMERC

C: Issue 51, Winter 2004 DMERC Medicare Advisory

C: Fee Schedule Update for 2005 for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

B: 2005 HCPCS Update http://www.adminastar.com/News/DMERCNews/files/DMERC_HCPCSUpdate2005.pdf

C: Completion of Medicare Certificates of Medical Necessity

C: Payment to Providers/Suppliers Qualified to Bill Medicare for Prosthetics and Certain Custom-Fabricated Orthotics

B: DMERC Only – Payment to Providers/Suppliers Qualified to Bill Medicare for Prosthetics and Certain Custom-Fabricated Orthotics

C: Wheelchair Seating Coding and Pricing Changes

C: Invalid Diagnosis Code Editing – Second Phase for DMERC

C: Correction to Summer 2004 Advisory Article

2004 Fee Schedule Amounts for Wheelchair Seat and Back Cushions

Region B
1) Remittance Advice Remark Code and Claim Adjustment Reason Code Update
2) Claim Submission for E0990; Elevating Legrests
3) FAQ: Clarification on the DMERC Advisories Relating to the New Codes for Wheelchair Cushions and Backs
4) Cash Transactions

D: "Quarterly Provider Update" - CMS publishes this Update to regulations at the beginning of each quarter.

C: Issue 49, Summer 2004 DMERC Medicare Advisory

C: 2004 Fee Schedule Amounts for Wheelchair Seat and Back Cushions

C: Remittance Advice Remark Code and Claim Adjustment Reason Code Update (June 2004) for DMERC

The October 2004 Medicare Bulletin is available Click here to view.

The Part B Vendor Gazette is now available.

New ANSI Front End Edit Additions and Changes effective 10/04/04 are available on the AdminaStar Federal website at the following hyperlinks:
Part B: http://www.adminastar.com/HIPAA/Carrier/Carrier.html
DMERC: http://www.adminastar.com/HIPAA/DMERC/DMERC.html
For a complete listing of the ANSI front end edits, view the "Part B/DMERC ANSI X12 4010A1 Front End Edit Error Manual" using the following hyperlink: http://www.adminastar.com/Providers/EDI/DMERC/HIPAA/HIPAA.html

Payment Allowances for the Influenza Virus Vaccine CPT 90658 and the Pneumoccocal Vaccine CPT 90732

C: MMA-Reasonable Charge Update for 2005 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, Therapeutic Shoes, and Certain Intraocular Lenses for DMERC

B: Quarterly Update: http://www.adminastar.com/Providers/DMERC/Links/Links.htm and click on “Quarterly Provider Update”

A: The Quarterly Provider Update can be accessed at www.cms.gov/providerupdate

Guidance Regarding Elimination of Standard Paper Remittance (SPR) Advice Notices in the Old Format for DMERC

Information regarding Epoetin Alfa (EPO) billing procedures and codes in ESRD is now available on the DMERC A Web site. To access this information, visit the "What's New" section (http://www.umd.nycpic.com/dme_what's_new.html)

DMERC Overpayment Refund Form

Update to Medicare Deductible, Coinsurance, and Premium Rates for Calendar Year (CY) 2005 for DMERC

C: Council Q & A, July 14, 2004

B: DMERC News You Can Use

Information and Education Resources for Medicare Providers, Suppliers, and Physicians for DMERC

Destination: Medicare, A Durable Medical Equipment, Home Health and Hospice Symposium presented by Palmetto GBA

October 1, 2004 Oral Anticancer Drug Fee Update

Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 10.3, Effective October 1, 2004

Additional Information: The CCI and MEC files will be maintained in the Internet Only Manual, Chapter 23, Section 20.9, which can be found at: http://www.cms.hhs.gov/manuals/104_claims/clm104index.asp

http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp
Application of the Medicare Secondary Payer for the Working Aged Provision to Former Spouses and the Medicare Secondary Payer for the Disabled Provision to Former Spouses and Certain Family Members with Coverage Under the Federal Employees Health Benefits (FEHB) Program

"Draft Policy - Knee Orthoses" "Draft Policy - Knee Orthoses" - The DMERCs have developed a draft local coverage determination (LCD) and draft policy article for Knee Orthoses.

MMA- Section 937 - Correction of Minor Errors and Omissions without Appeals for DMERC
Understand the Medicare rules that enable you to correct minor errors and omissions on Medicare claims without having to go through the appeals process. This article will provide information needed to make such minor corrections to Medicare claims within existing procedures.

GPNet Edit Manual - September 2004
Palmetto GBA uses an EDI Gateway called GPNet for SC Part A, NC Part A, RHHI, SC Part B, DMERC & Railroad electronic transactions. The GPNet Edit Manual includes a list of GPNet Edit codes and descriptions that may appear on the GPNet Response Report.

Wheelchair Seating – Correction
The September 2004 Supplier Manual update includes a revision of the Wheelchair Seating policy. Since that update, an additional correction has been identified relating to the ICD-9 code section of the LCD for combination skin protection and positioning seat cushions (K0656 and K0657).

Region C DMEPOS Supplier Manual (updated through Autumn 2004)
The Region C DMERC DMEPOS Supplier Manual has been updated for Autumn 2004.