Medicare Compliance & Reimbursement

Providers and contractors alike have been confused about certain elements of billing for diabetes outpatient self-management training (DSMT), but recent guidance from the Centers for Medicare & Medicaid Services should set the record straight. In program memorandum B-03-043 (http://cms.hhs.gov/manuals/pm_trans/A03043.pdf), CMS clarifies that "incident to" supervision rules and other "incident to" requirements do not apply to DSMT services. The agency explains that the legislation that authorizes DSMT payments does so in a "stand alone" provision that is not subject to the separately outlined incident-to requirements. In other recent program memoranda, CMS:
explains its position on the implementation of the therapy cap (AB-03-073; http://cms.hhs.gov/manuals/pm_trans/AB03073.pdf);
touts the availability of the CMS Quarterly Provider Update (AB-03-075; http://cms.hhs.gov/manuals/pm_trans/AB03075.pdf);
revises policies relating to the suspension of payments to providers that don't file their cost reports in a timely fashion (A-03-042; http://cms.hhs.gov/manuals/pm_trans/A03042.pdf);
issues a supplement to the National Council for Prescription Drug Programs batch transaction standard 1.1 (B-03-041; http://cms.hhs.gov/manuals/pm_trans/A03041.pdf);
issues instructions to contractors on using remittance advice notices when denials are based on excess frequency (AB-03-076; http://cms.hhs.gov/manuals/pm_trans/AB03076.pdf); and
addresses the bi-annual update to the health care provider taxonomy code (B-03-042; http://cms.hhs.gov/manuals/pm_trans/B03042.pdf).