If you're in one of 10 DME bidding areas starting this summer, you'll no longer be able to furnish certain items.
Even if you're a home health agency or hospice, Medicare's competitive bidding program for durable medical equipment still could change your life as early as this summer.
HHAs and hospices won't be able to furnish or bill for DME bidding items in competitive bidding areas once the program takes effect, the Centers for Medicare & Medicaid Services reminds providers in Transmittal No. 1431 (CR 5868) updated Feb. 1. And providers will have to partner with bid winners for contracted DME subject to bidding.
Bidding will launch in 10 areas in July and spread to 70 areas next summer. (For a list of the 70 areas, see Eli's HCW, Vol. XVII, No. 2).
"HHAs that furnish DME and are located in an area where DME items are subject to a competitive bidding program, must either be awarded a contract to furnish the items in this area or use a contract supplier in the community to furnish these items," CMS explains in instructions added to the transmittal. "The competitive bidding items are identified by HCPCS codes and the competitive bidding areas are identified based on ZIP Codes where beneficiaries receiving these items maintain their permanent residence."
Intermediaries that receive claims with bid items on them will return the claims to the provider. An agency then will have to delete the DME items and submit the separate DME claims to the DME MAC if the provider has a bid contract.
The transmittal is online at
www.cms.hhs.gov/transmittals/downloads/R1431CP.pdf. • Even if you haven't had any National Provider Identifier-related problems yet, you should still double-check your National Plan and Provider Enumeration System information. That's because NPPES will establish a "verification process" with the Internal Revenue Service to check providers' legal names and employee identification numbers (EINs) against its files, CMS says in a message to providers. And if your NPI on your claims isn't backed up by correct NPPES records, the system will deny them. • HHAs and hospices served by the Associated Hospital Service component of National Government Services will see some payment disruption as the intermediary switches to the HIGLAS ac-counting system.
NGS announced last summer that it would switch to HIGLAS in August and now it's completing another transition, says a message to providers posted on AHS' Web site at
www.ahsmedicare.com/files/documents/021408_HIGLAS.pdf.
The change, which affects the financial accounting system and not the claims system, will add time to request for anticipated payment (RAP) processing and could introduce a host of other payment-related confusions. HHAs had trouble with new withholding rules, among other items, when regional home health intermediary Palmetto GBA switched to HIGLAS in 2005 (see [...]
