New DME MACs add to requirements.
Suppliers of power mobility devices (PMDs) aiming for clean claims have a new hoop to jump through--a list of revised claim documentation requirements from the new Medicare administrative contractors (DME MACs).
If suppliers fail to sort out the new requirements--and how those requirements mesh with the final rule on PMD documentation released in April, they could see a spike in denied claims starting next month, caution experts including Eric Sokol, director of the Power Mobility Coalition.
Background: The Centers for Medicare & Medicaid Services published its final rule on documentation for power wheelchairs and power operated vehicles in the Federal Register on April 5. It became effective for claims with dates of service on or after June 5. Then, earlier this month, the new DME MACs took the reins from the durable medical equipment regional carriers (DMERCs) in regions A, B and C.
What's new: On July 14, Palmetto GBA led the way in framing the new PMD documentation requirements for suppliers. The MACs' final word on PMD claims documentation is effective for all claims on and after Aug. 24.
The MACs reiterate the final rule's 45-day timeframe for providers to receive the documentation, reports Seth Johnson, chair of the American Association for Homecare's Rehab and Assistive Technology Council. Don't Miss These Documentation 'Musts' But the MACs have introduced plenty of new requirements. Key points in the new guidances include the following:
• Suppliers must date-stamp all documentation upon receipt from physicians.
• Suppliers are required to prepare a written document that lists the specific base (HCPCS code and manufacturer name/model) and
all options and accessories that will be separately billed, notes an overview supplied by AAHomecare.
• Suppliers must break out their charge and the Medicare fee schedule allowance for each separately billed item. The physician must sign and date this detailed product description and the DME supplier must receive it before delivery of the power mobility device.
• The MACs have also made significant changes to documentation requirements related to the face-to-face visit (see "Docs Play Key Role In Securing Payment For Mobility Devices" later in this issue for more information).
Clarification: The DME Program Safety Contractors released revisions of the power wheelchairs and power operated vehicles policies as part of their Supplier Manual update in June. Although those revisions also incorporate the final rule's 45- day time frame, they do not include the MACs' new documentation requirements.
Lesson learned: For the latest word on what you will need to submit clean PMD claims, go directly to the MACs' guidance documents.
Note: The Palmetto GBA guidance is available at:
www.palmettogba.com/palmetto/providers.ns(Docs)/85256D580043E754852571A800430A1B?OpenDocument.
