Medicare Compliance & Reimbursement

Plus: New DME competitive bidding program advice adds meat to Medicare's Claims Processing Manual You'll have to keep waiting for Medicare to expand coverage for intracraninal stenting and angioplasty, thanks to a May 12 CMS transmittal that confirms Medicare's refusal to provide additional coverage for these services. The request for coverage, which was submitted by Boston Scientific Corp., specifically requested coverage for the Wingspan Stent System with Gateway PTCA Balloon Catheter. Boston Scientific noted in its request that the product could be useful in treating intracranial atherosclerotic disease, refractory to medical therapy in intracranial vessels with 50 percent or more stenosis. CMS noted, however, that Medicare will continue to cover PTA and stenting of intracranial arteries for the treatment of cerebral artery stenosis of over 50 percent in patients with intracranial atherosclerotic disease "when furnished in accordance with the FDA-approved protocols governing Category B IDE trials." The decision on intracranial stenting and angioplasty is available online at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=214. In Other News ... • If you've been confused about the new durable medical equipment (DME) competitive bidding program, Medicare strives to make your life easier with the addition of a new chapter on the subject in the Medicare Claims Processing Manual. New chapter 36 offers "instructions for Medicare contractors for the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program," according to an announcement last week about the chapter addition. The new chapter will be the first of many, CMS says, and it also includes sample notification letters "that suppliers may use to notify Medicare beneficiaries of whether or not they elect to become a grandfathered supplier." To read more about the new information, visit the CMS Web site at http://www.cms.hhs.gov/transmittals/downloads/R1502CP.pdf. • By winning a five-year contract worth about $148 million, National Heritage Insurance Corporation has become the administrator of Part A and Part B Medicare claims payment in Alaska, Idaho, Oregon and Washington. Centers for Medicare & Medicaid Services Acting Administrator Kerry Weems says the contract will improve service to beneficiaries and healthcare providers, according to a May 6 press release. "In awarding these contracts, CMS is ensuring that each Medicare contractor continues to provide the best overall value to the government and the American taxpayers," Weems says.