CMS, DME MACs Busy with Messages, Reminders

BALTIMORE — CMS’ DME MACs issued several notable messages
over the past two weeks, including:

ABNs on Group 2 POVs and Group 4 PWCs

A policy revision allowing the use of ABNs on Group 2
POVs and Group 4 PWCs. According to an April 28 message
from Cigna Government Services, the Jurisdiction C DME MAC (and
followed by others), the power mobility devices local coverage
determination and policy article are being revised to allow the use
of Advanced Beneficiary Notices for Group 2 power operated vehicles
(K0806-K0808) and Group 4 power wheelchairs (K0868-K0886) so that
consumers can elect upgrades that best suit their needs.

Recent revisions to the previous policy eliminating the least
costly alternative had the unintended consequence of classifying
these items as “non-covered” by Medicare, the MACs said, making
them ineligible for the ABN upgrade process. The change will be
effective for dates of service on or after June 1, 2011. The
revised LCD and policy article will be published in the near
future, the message said.

Read the notice in full on the Jurisdiction C
website.

CMS’ definition of “home”

A reminder on what CMS calls “home.” An April
22 message from National Government Services said the Jurisdiction
B DME MAC had received a number of questions about place of service
for DMEPOS.

According to the NGS reminder: “Medicare payment is available
for rental or purchase of durable medical equipment used in a
beneficiary’s home. A beneficiary’s home may be his/her own
dwelling, an apartment, a relative’s home, a home for the aged, or
other type of institution. However, an institution may not
be considered a beneficiary’s home if it is a hospital or a skilled
nursing facility.

“If an individual is a patient in an institution or a distinct
part of an institution that meets the definition of a hospital or
skilled nursing facility, the individual is not entitled to have
separate Part B payment made for rental or purchase of durable
medical equipment. This concept applies even if the patient resides
in a bed or portion of the institution not certified for
Medicare.”

NGS said coverage for any DMEPOS item will be considered if the
place of service is:

• 01 – Pharmacy
• 04 – Homeless Shelter
• 09 – Prison/Correctional Facility
• 12 – Home
• 13 – Assisted Living Facility
• 14 – Group Home
• 33 – Custodial Care Facility
• 54 – Intermediate Care Facility/Mentally Retarded
• 55 – Residential Substance Abuse Treatment Facility
• 56 – Psychiatric Residential Treatment Center
• 65 – End Stage Renal Disease (ESRD) Treatment Facility (valid
  POS for Parenteral Nutritional Therapy)

For a complete list of place of service codes, see http://www.cms.gov/PlaceofServiceCodes.

New articles from the Medicare Learning Network

In addition to the DME MAC messages, check these new
articles from the Medicare Learning Network. MLN Matters
article MM7213 discusses new “reasonable useful lifetime” policies
for instances where the beneficiary has both portable and
stationary oxygen equipment and the RUL for one piece of equipment
expires before the RUL for the other piece of equipment has been
reached. The new policies related to CR 7213, released April 8,
apply to oxygen and oxygen equipment furnished to Medicare
beneficiaries in general and are not restricted to that furnished
to beneficiaries in competitive bidding areas, the article notes.
The effective date is May 8, 2011. Read MM7213 in full at http://www.cms.gov/MLNMattersArticles/downloads/MM7213.pdf.

A new fact sheet titled “Signature Requirements” includes
information on the CERT contractor’s signature requirements: It has
to be legible, the fact sheet says. Download a PDF from the
Medicare Learning Network at http://www.CMS.gov/MLNProducts/downloads/Signature_Requirements_Fact_Sheet_ICN905364.pdf.