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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