ReaDME: The latest in DME news

The latest in DME news, from regulations and guidelines to payer and patient trends.

Comments on the ESRD Proposed Rule that contains new competitive bidding language is due September 10. Until the release of the Final Rule, on or after November 1st, there will be no new details on how competitive bidding will look for the future. In the meantime, providers have asked that CMS release some guidance on the transition period to an “any willing provider” type of system starting January 1, 2019 until the next bidding round begins.


The Power Mobility Device Demonstration ended August 31, 2018. However the Condition of Payment Authorization Program was extended to include 31 additional codes to the two existing codes, K0856 and K0861. The Condition of Payment Authorization Program is nationwide. Be sure to send your requests for prior approval to the correct location and it is preferred by the MACs to use their cover page when sending a request. Please see the contractor websites for any additional information and to find the applicable HCPCs codes added to the program.


Contractor for Regions B and C
Contractor for Regions A and D

Healthcare Updates

Upcoming events and news to keep you ahead of the curve.

Beginning October 1, 2018, the requirement to append the KH modifier to Complex Rehab capped rental items that are being purchased has been removed. This should assist with having to use the 99 modifier to append more than 4 modifiers on a claim.


According to the Medical Director of the Region C DME MAC, Dr. Hoover, the LCDs will be getting a makeover in the future. Due to the 21st Century CURES Act, the requirements to change an LCD have become burdensome requiring comment periods on all types of changes to the published document. As a result the plan is to add more content to the policy article associated with each LCD. Please be sure to check the LCD and related policy articles for each product to ensure all coverage criteria have been met.

Best Practices

Do’s and don’t’s developed to maximize returns and minimize denials.

Are you updating your price files with each contract renewal? If not, booked revenue will be miscalculated until the remittance is received from the payer. Be sure to have your contracting department work closely with the department handling your price files to ensure accurate price file maintenance.