ReaDME: The latest in DME news December 2018

CMS released the multifunction ventilator procedure code, E0467, in the new codes effective for January 2019. Please be advised this is a bundled item and includes payment for any of the equipment that provide the stand alone functionality the new ventilator can provide. See the MLN Matters Article regarding the bundling methodology.

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CMS has instructed the DME MACs to roll out a new Serial Claims Initiative that aims to reduce denials by holding claims processing until initial claim reviews are complete, then process the claims submitted similarly to the reviewed claim. In addition, it will allow providers to use the PWK segment to send additional documentation for claims processing even after the medical record review has been started. It is being applied to claims currently under Medical Review, and will be implemented in waves by procedure code. Please see the DME MACs websites for additional information on how each one plans to roll this out to suppliers.

A recent OIG report on the study of CPAP supply claims has concluded that most claims submitted to Medicare for pap supplies do not meet the Medicare requirements for coverage.  The sample of 110 claims for CPAP supplies showed 86 claims did not meet the guidelines. As a result, auditing contractors are on alert for these products.

Is your staff prepared to handle the onslaught of insurance changes that become effective January 1? Be sure to remind staff to ask patients about their policy information to ensure your insurance claims are going to the correct payer for the upcoming year.