Medicare Compliance & Reimbursement

CMS issued a change request for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) in June to better align with 2016 fee schedule amounts and outlined in the Medicare Claims Processing Manual in Chapter 20, Section 20.6.

The changes were “mandated by Section 16007 of the 21st Century Cures Act” and are being processed retroactively by the Medicare Administrative Contractors (MACs) across all jurisdictions, states the revised MLN Matters change request MM9968.

MAC updates: DMEPOS suppliers should check their Medicare Remittance Advice statements as thousands ofclaims per day are adjusted, noted CGS Medicare in a release.

More than half of the adjustments are complete for Noridian Healthcare Solutions, the MAC says. But Noridian notes that a “small volume of claims adjustments” resulted in “overpayments” that may have already been refunded. “We are working with the Shared Systems Maintainer to best correct this problem,” says the MAC on its website.

The implementation or CR release date is now Oct. 2, 2017. All MACs are required to add the new Remittance Advice Remark Code (RARC) N689 to all adjusted claims and advise Medicare billers to update their records and reach out to MACs in their jurisdiction with questions.

Resource: To review the MLN Matters MM 9968, www.cms.gov/Outreach-and-Education/Medicare-Learning- Network-MLN/MLNMattersArticles/Downloads/MM9968.pdf.