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.