CMS Issues Billing Updates under Bidding

BALTIMORE — On Jan. 3, the first full business day after
competitive bidding was
implemented over the New Year weekend, a CMS message said the
agency has identified a “possible problem” when grandfathered
suppliers submit claims for purchased accessories and supplies for
use with grandfathered equipment under the bidding program.

CMS has created a temporary solution to allow grandfathered
suppliers to be paid for such items, but they must append the
affected HCPCS codes with the KY modifier, the notice said:

“Specifically, in order to secure payment, grandfathered
suppliers must use the KY modifier on claims with dates of service
on or after Sat., Jan. 1, 2011, for purchased, covered accessories
or supplies furnished for use with grandfathered
equipment.

“The HCPCS codes identified below are the codes for which
use of the KY modifier is authorized.

• Continuous Positive Airway Pressure Devices, Respiratory
  Assistive Devices, and Related Supplies and Accessories: A4604,
  A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038,
  A7039, A7044, A7045, A7046, E0561, E0562
• Hospital Beds and Related Accessories: E0271, E0272, E0280,
  E0310
• Walkers and Related Accessories: E0154, E0156, E0157,
  E0158.”

CMS said affected claims for these items without the KY modifier
will be denied.

However, reimbursements using the temporary solution will result
in payment on a fee schedule basis rather than payment using the
single payment amounts. Further information on whether and how
claims will be adjusted when such claims are paid using fee
schedule amounts is forthcoming, the agency said, as is information
on a permanent solution.

Read the notice in full on the Jurisdiction C
website.

For more information on the use of claims modifiers under
competitive bidding, see MLN Matters SE1035.

Yesterday the CBIC also posted an updated Q&A on billing to
its website:

Does the hospital exemption for the DMEPOS competitive
bidding program allow a hospital to bill for walkers furnished to
its patients with Original Medicare on the day of an outpatient
hospital service?

No. In this case, a contract supplier for the walker product
category in the CBA would have to furnish the walker for Medicare
Part B to pay. The hospital exemption only applies when the
beneficiary has first been admitted to the hospital. If a hospital
in a CBA submits a claim for a walker furnished to a patient who is
a beneficiary with Original Medicare and there is no corresponding
claim for the inpatient hospital stay, the claim will be
denied.

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stories.