Medicare Compliance & Reimbursement

Plus: One code will increase 12 percent next year.

In 18 states and the District of Columbia, "DMERC" will be an acronym of the past come July 1.

 On that date, two durable medical equipment Medicare administrative contractors (DME MACs) ...quot; National Heritage Insurance Company Inc. and AdminaStar Federal ...quot; will each assume full responsibility for the work of their assigned geographic jurisdictions, taking over from the durable medical equipment regional carriers (DMERCs).
 National Heritage will serve suppliers in Jurisdiction A, which includes Connecticut, Delaware, the District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont. Its Web site is www.medicarenhic. com/dme/index.shtml.
 AdminaStar Federal will serve suppliers in Jurisdiction B: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin. Its Web site is www.adminastar.com/Providers/DMERC/ContractorReform/ContractorReform.html.
 Contract disputes have held up the transition to the DME MACs in jurisdictions C and D, reports the Centers for Medicare & Medicaid Services (CMS). But Noridian Administrative Services should be able to assume full responsibilities for the Jurisdiction D by the end of 2006.
 "At the current time, no transition activity is occurring with respect to the DME MAC for Jurisdiction C, nor is there any activity with respect to implementing the four contract options," CMS says.
CMS Comes To Your Rescue On
IVIG Payments

 Your payments for Part B drugs won't change much in the third quarter of 2006 ...quot; except for intravenous immune globulin (IVIG).
 CMS says payment amounts for all drugs, including the drugs physicians administer most often, will rise by around 0.5 percent on July 1. Physicians administered these drugs more often in 2005 than in 2004, according to CMS.
 Payment amounts changed by less than 2 percent for 28 out of the 50 most-prescribed drugs. Payments went up for 30 out of the top 50 drugs, and three drugs remained the same. CMS says some of the top drugs saw decreases due to multiple sources, alternative therapies, new products or the rise of lower-priced products.
 Good news: Your IVIG squeeze may be almost over. Many advocacy groups and physicians had warned that patients were having a hard time obtaining IVIG at CMS' payment rates. In response, CMS is raising payments by 11.9 percent for powdered IVIG and 3.5 percent for liquid IVIG.
 CMS says it will keep working with manufacturers and other groups to try and figure out ways to make IVIG accessible to patients.
 Note: You can see the new payment rates online at: www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/02_
aspfiles.asp.

In Other News...

 • It may get harder to figure out whether your contractor has received your appeal request under newly manualized changes to the Medicare appeals process. CMS no longer requires intermediaries and carriers to send acknowledgement letters for requests for Hearing Officer hearings, CMS says in a June 16 transmittal (CR 5058).
 The transmittal also makes other changes to the appeals portion of the Medicare Claims Processing Manual, including adding a question on overpayments to the reconsideration request form; eliminating contractors' requirement to notify Qualified Independent Contractors of effectuation amounts; and clarifying the Medicare Appeals Council's options in reviewing Administrative Law Judge decisions and dismissals.
 The transmittal is at www.cms.hhs.gov/trans mittals/downloads/R985CP.pdf.
 • Two Louisiana home care workers have been arrested on charges of Medicaid fraud. New Iberia residents Christina Mitchell and Mary A. Fuslier are charged with multiple fraud counts for submitting false claims to their employer, Unlimited Home Care in Villa Platte, according to a release from Attorney General Charles C. Foti, Jr.
 Mitchell and Fuslier submitted claims for hours they didn't actually work, prosecutors charge. "UHC fully cooperated with this investigation," the release notes.
 • The owner of 1st Choice Medical Supplies and Equipment pleaded guilty May 30 to multiple charges of Medicare fraud, according to the Department of Justice.
 During his plea, Harold Iyalla admitted that as president of the Houston, TX-based DME firm, he engaged in a scheme to defraud Medicare by billing the program for motorized wheelchairs that were either not required by the beneficiary, not delivered or both.