ReaDME: The latest in DME news January 2019

Medicare DME MACs released a joint publication requiring that claims with dates of service after March 1, 2019 where the LCDs have bilateral indicative modifiers, RT and LT, that the left and right items be separated on the claim as two line items. Previously, it had been acceptable to have one claim line item with two units of service with both modifiers appended to indicate the patient received bilateral versions of the item.

The Competitive Bid Temporary Gap Period began 1/1/19. Any Medicare enrolled provider can provide services to Medicare beneficiaries during the gap period. If the claim is assigned, the provider accepts the reimbursement outlined in this article https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10838.pdf. However, unassigned claims are acceptable as the contracts are termed.

CMS released the annual update to the Medicare Deductible, Coinsurance and Premiums for 2019. Medicare Part B coinsurance remains 20%, but the deductible increased to $185.00. The deductible in 2018 was $183.00.

Are you verifying your Medicare patient’s eligibility? January is the most common month for beneficiaries changing to a Medicare Managed Care Organization, or MCO. Be sure to check the eligibility of the beneficiary under the Part C benefits to ensure the claims are being sent to the correct place, and to ensure your organization can continue to provide service for your patients if the MCO is out of network.