Medicare Compliance & Reimbursement

Are DMERCs ready for the end of power mobility CMNs? Why some think they're not.

Two durable medical equipment Medicare Administrative Contractor jurisdictions have hit a bump in the road transitioning to the new claims processing environment, and the result could be further confusion for suppliers.

DME MACs National Heritage Insurance Company in Region A and AdminaStar Federal Inc. in Region B are getting ready to prepare suppliers for the transition from the current DME regional carrier claims processing environment, Centers for Medicare & Medicaid Services staffer Sue Lathroum told listeners during a recent home health, hospice and DME Open Door Forum.

But a protest of the MAC awards has stalled preparations for Palmetto GBA in Region C and Noridian Administrative Services in Region D. CMS didn't identify the protester by name. But current Region D DMERC CIGNA, which Noridian will replace, filed the protest for both regions C and D, CIGNA spokesperson Gloria Barone tells Eli.

CIGNA filed the protest with the Government Accountability Office, which has until May to make a decision, says Lathroum. The protester had a stay of decision, but CMS overrode the stay, so the protester has taken the case to court where hearings are underway. "Our desire is to proceed and to prepare for implementation in those two jurisdictions as quickly as we can," she maintains.

Suppliers hoping to get more MAC transition information directly from CMS are out of luck. The agency recently held its first monthly meeting with representatives of supplier organizations to discuss the DMERC-to-DME MAC transition, Lathroum reveals. CMS plans to continue meeting with supplier organization representatives, rather than having an Open Door Forum on the transition as suppliers requested.

During the MAC meeting, CMS staff outlined contractor reform goals under the Medicare Modernization Act and the DMERC-to-MAC transition timeline, the American Association for Homecare reports.

CMS expects July 1 to be the "cut-over" date in the four DME MAC regions. Prior to that date, suppliers will have an opportunity to test claims submission to the new MACs, AAHomecare says.

Suppliers in the forum also wanted to know about wheelchair certificates of medical necessity. Effective April 1, suppliers will no longer need to electronically submit the CMN for wheelchairs to the four DMERCs.

But the DMERCs haven't indicated that they are ready to accept this new arrangement, caller Kimberlie Rogers-Bowers with Lake Forest, CA-based Apria Healthcare Group Inc. said during the forum.

"That doesn't mean that they're not ready," responded a CMS staffer.

Finally, suppliers will have to wait a while longer for the competitive bidding proposed rule. The rule is still held up in the clearance process, CMS notes.