Medicare Compliance & Reimbursement
DMAC Transition Delayed Until Fail In 2 Regions
Suppliers in Medicare Region C or D can put off worrying about durable medical equipment claims processing changes for a while.
The Centers for Medicare & Medicaid Services has extended its contracts with Region C DME regional carrier Palmetto GBA and Region D DMERC CIGNA Government Services until Sept. 30, a CMS official said in a recent Open Door Forum for home health agencies, hospices and DME suppliers.
The extension is necessary because CIGNA's protest against the Durable Medical Equipment Medicare Administrative Contractor (DMAC) contracts for those regions is still pending before the Government Accountability Office, the CMS staffer explained. CMS originally planned to switch all four DME regions to the new DMACs July 1, but now regions C and D are on hold until the GAO rules in early May.
CMS has extended the Palmetto and CIGNA contracts because it wants to ensure no break in claims processing for suppliers, the official said. If the DMAC issue isn't resolved before the contracts are up, CMS will make available an advance payment system to avoid cash flow problems, she added.
The DMAC hold also affects suppliers in other regions. Suppliers in any state that was supposed to move into or out of Region C or D are also on hold until the protest is resolved, the staffer warned listeners.
Meanwhile, CMS soon will issue frequently asked questions about the normally progressing DMERC-to-DMAC transition in Regions A and B. The FAQ sheets will include information on claims processing, appeals, enrollment and more, she said.
And CMS is in the midst of the next phase of the Medicare Administrative Contractor transition, choosing Part A and Part B MACs to replace the current Part A intermediaries and Part B carriers.
The agency will announce the first of those awards in late June, the official said.
CMS Clarifies Additional DME Issues
CMS addressed the following DME issues at the Open Door Forum:
Power mobility rule. Although suppliers will have to wait for the official CMS instructions to be sure, most likely the June 5 effective date for the power mobility device final rule is based on date of service, not date of billing, a CMS official explained. The rule eliminates the certificate of medical necessity for PMDs, requires a face-to-face exam before physicians prescribe PMDs and requires the physician to furnish supporting documentation.
Competitive bidding. The highly anticipated proposed rule on competitive bidding for DME should be out "any day now," CMS promised.
UPINs. CMS has pulled back its ban of surrogate Unique Physician Identification Number OTH000, a staffer explained. The agency rescinded the surrogate UPIN change "due to the potential for adverse impact to providers billing the program," he said. More information is at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5019.pdf.
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