Jurisdiction B Requiring Narrative for Some Diabetic Test Strip Claims

The Medicare Administrative Contractor for Jurisdiction B, National Government Services, will require suppliers to include a narrative explanation, effective Feb. 1, when submitting claims for test strips for a noninsulin treated diabetic beneficiary (KS modifier) in quantities of 10 or more units of service. The DME MAC reported that it is implementing the change because of a high volume of claims for diabetic test strips (A4253KS) with an incorrect number of services.

New Webcast for Round 2 and National Mail-Order Bidders Now Available

The first in a series of educational webcasts for the Round 2 and national mail-order competitions of the DMEPOS Competitive Bidding Program is available on the competitive bidding website. This webcast provides background information on the program and information about educational resources.  There is no charge to view the webcast, and a transcript is also posted.

Justice Department Reports $2.4 Billion in False Claim Recoveries

The government has recovered $2.4 billion in false claim cases in fiscal 2011, involving mostly federal health programs, the Department of Justice announced last week. The civil cases brought under the False Claims Act involved fraud committed primarily against Medicare and Medicaid but also TRICARE, federal Employees Health Benefits and Veterans Administration health programs. In fiscal 2010, the government recovered $2.5 billion in false claims.

Q&A Transcript from Jurisdiction B DME MAC Now Available

The Jurisdiction B DME MAC Council Q&A document is now available on the National Government Services website. The meeting was held on Thursday, November 17, 2011 in Indianapolis, Ind. The Q&A covered issued involving enteral/parental IV therapy, respiratory care equipment/oxygen therapy, rehab equipment and other issues including documentation and regulatory problems.

AMEPA Reports Registration Problems for Competitive Bidding Round 2

Accredited Medical Equipment Providers of America (AMEPA) reported last week that some HME providers were encountering delays in the competitive bidding Round 2 registration process.

The delays were coming on the eve of the Dec. 22 “Target Registration Deadline” set by Medicare. However, the official deadline for registration is 9 p.m. Feb. 9. Medicare wanted providers to register early in case there were difficulties.

Committee Leaders Ask for Information on ZPICS and MACs

Republican leaders from the House Energy and Commerce Committee have written a letter to the Centers for Medicare & Medicaid Services asking for information on oversight of two Medicare fraud contractor programs.

The congressional members want information from 2007 until present on the Zone Program Integrity Contractor (ZPIC) program and the Medicare Administrative Contractor (MAC) program.

After Congressional Prodding, CMS Announces Independence at Home Program

The Centers for Medicare & Medicaid Services on Dec. 20 announced the creation of the Independence at Home program, a three-year initiative that will allow up to 10,000 Medicare patients to receive care at home.

The announcement came after Sen. Ron Wyden, D-Ore., and Rep. Edward Markey, D-Mass., sent a letter to Marilyn Tavenner, acting director of CMS, asking that the Independence at Home demonstration project be given higher priority.

Dream Connects with VGM to Offer Prescription, Medical Necessity Software

Dream Software and VGM Group Inc. have joined forces to help providers standardize prescription and documentation of HME medical necessity, an important element of audits. Dream offers real-time electronic prescribing and automated documentation software. The software requires that all supporting documentation be provided before HME delivery. E-prescribing HME reduces physician time by more than 65 percent, compared to paper, Dream says.

Sunrise Medical launches ‘JAY Your Way’ Cushion Modification Service

Sunrise Medical of Fresno, Calif., on Dec. 13 announced the launch of JAY Your Way, a custom modification service provided on select JAY cushions and backs.  JAY Your Way can be used to create a cushion or back manufactured to users’ exact specifications and needs.  It offers modifications to foam cushion bases, fluid inserts, backrests and covers.

Early Retiree Reinsurance Program Fund Shutting Off Claims

A fund to help cover health insurance for more than 5 million early retirees will stop taking claims for expenses incurred after Dec. 31, according to a notice in the Federal Register. Set up under health care reform, the fund is used to reimburse employers who subsidize health insurance for early retirees, ages 55 to 64, not yet eligible for Medicare. The Early Retiree Reinsurance Program fund started with $5 billion, and was intended to last through 2013. However, by Dec.

CMS Posts 2012 ICD-CM Code Updates on Website

The Centers for Medicare & Medicaid Services has posted the 2012 ICD-10-CM code updates to its website. This includes the 2012 ICD-10-CM index and tabular, code titles, addendum, General Equivalence Mappings (GEMs), and reimbursement mappings files. The 2012 ICD-10-CM files contain information on the new diagnosis coding system, ICD-10-CM, that is being developed as a replacement for ICD-9-CM, Volumes 1 and 2.

Former CMS Head Berwick Blasts States for Restricting Hospital Stays

Several states are severely restricting hospital stays in an “nonsensical” effort to hold down costs, and that amounts to health care rationing, says Dr. Donald Berwick, who recently resigned as administrator of the Centers for Medicare & Medicaid Services. "The amount of care that a Medicare beneficiary should get should be the amount of care they need. Otherwise, isn't that rationing?" he asked in an interview with Kaiser Health News.