ReaDME: The latest in DME news March 2019

Healthcare Updates

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

CMS released the change request to the DME MACs to update the fee schedule during the Competitive Bid Gap period effective April 1, 2019. Be sure to review the pricing update once it is uploaded by the MACs.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11179.pdf

On March 7, 2019, CMS announced plans to consolidate the competitive bidding areas (CBAs) included in the Round 2 Recompete and Round 1 2017 DMEPOS Competitive Bidding Program into a single round of competition named Round 2021. Round 2021 contracts are scheduled to become effective on January 1, 2021, and extend through December 31, 2023.

https://www.dmecompetitivebid.com/cbic/cbic.nsf/DocsCat/Home

In addition CMS has provided the following timeline for Round 2021 of the Competitive Billing Program.

March 7, 2019

The Centers for Medicare & Medicaid Services (CMS) begins pre-bidding supplier awareness program

May 2019

CMS announces dates for registration and bidding
CMS begins bidder education program

June 2019

Bidder registration period to obtain user IDs and passwords begins
Bid window opens

The below link can be utilized to view updates to the program as well as join the mailing list for future updates.

Competitive Bidding Implementation Contractor (CBIC)

Best Practices

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

The GW modifier is defined as “SERVICE NOT RELATED TO THE HOSPICE PATIENT’S TERMINAL CONDITION”. The modifier is meant to be used when a patient is currently under Hospice care, but may need equipment and supplies not related to the hospice diagnosis. If the condition to which the DME is attempting to bill for equipment or accessories is not related to the condition the patient has been deemed the condition for the hospice stay, make sure to append the GW modifier on the DME claim to ensure proper payment.