In Brief

In an early alert memorandum released Nov. 26, HHS’ Office of
Inspector General notified CMS that some DMEPOS suppliers
with outstanding Medicare debt may still be receiving payments by
operating companies that are publicly fronted by business
associates, family members or other individuals posing as
owners. In a random sample of 10 DMEPOS suppliers in Texas
that collectively had Medicare debt of $8.5 million during
2005-2006, the OIG found six of the 10 were associated with 15
other suppliers or HHAs that received Medicare payments totaling
$58 million during 2002 to 2007. Billing numbers for eight of the
10 were revoked in either 2003 or 2004, and the remaining two went
into inactive billing status in 2000 or 2001. Read the OIG report.

A recent review of claims for budesonide has identified
problems with the coding and coverage of the inhalation
drug, according to the DME MACs. Read the notice on the Noridian Web site.

In a recent clarification on accreditation reported by
AAHomecare last week, Palmetto GBA said providers of drugs
and pharmaceuticals who also bill for DMEPOS outside of
pharmaceuticals must be accredited to obtain or maintain Medicare
billing privileges. Pharmacy providers must update their
file with the National Supplier Clearinghouse using the CMS-855S
enrollment form. If a pharmacy seeks the accreditation exemption,
all other products/services must be removed.

Last week CMS released its ICD-10-Clinical
Modification/Procedure Coding System Fact Sheet,
which gives general information about the International
Classification of Diseases, including benefits of adopting the new
coding system, structural differences between ICD-9 and ICD-10 and
implementation planning recommendations. To order the new fact
sheet, go to http://www.cms.hhs.gov/MLNProducts/01_Overview.asp and
then scroll to “Related Links Inside CMS” and select “MLN Product
Ordering Page.”

Noridian Administrative Services, the DME MAC for
Jurisdiction D, now offers a lookup tool for fees,
including DMEPOS, drug, dispensing and pharmacy supply fees, and
parenteral and enteral nutrition fees. View the tool on the Noridian Web site.