Ask the DMERC MDs

Saturday, December 31, 2005

Welcome to the New Year. Usually this column focuses on a single current topic but this month we'll touch on a potpourri of current DMEPOS issues.
As of this writing (early December), this area is relatively quiet. To summarize the status of various MAE issues:
- MAE National Coverage Determination has been in effect since May 5, 2005.
- The Power Operated Vehicle, Manual, and Motorized Wheelchair Base LCDs have been updated to include the MAE NCD Criteria.
- The Draft LCD, Power Mobility Devices, has completed the comment period. It is currently on hold pending revision to the HCPCS code set.
- The proposed HCPCS code set is under review. Release of a revised set of codes is expected in 2006.
- The Interim Final Rule is effective, implementing a face-to-face exam requirement for all power mobility items.
- The Certificate of Medical Necessity (CMN) for POVs, and wheelchairs, has been eliminated. At this time, only Section A needs to be completed and submitted. Effective April 1, 2006, no information will need to be submitted.
As we discussed last month, CMS has been rebidding and rearranging the DMERC contracts. There have been a few developments since we last wrote about this issue.
- Trust Solutions has been awarded the contract as the Region C DMERC Program Safeguard Contractor (PSC). Dr. Adrian Oleck will be the Medical Director.
- Q2 Administrators has been named as the Qualified Independent Contractor (QIC) to handle Hearings for all of the DMERCs. Dr. Stacey Brennan has left her position as the DMERC Region C Medical Director to assume the medical director position for Q2 Administrators.
On Jan. 1, the new HCPCS codes take effect. This is always a busy time of year, and it is easy to miss a new code or a change to an existing code. Please take a moment and check the codes for the items that you bill for any changes. Information about coding is available from the CMS, SADMERC or DMERC Web sites.
Also, remember that there is no grace period for the use of discontinued HCPCS codes. Use of an invalid code will result in a denial of the claim.
As new codes are created, questions often arise about which products the code applies to, whether there is coverage or reimbursement for the item or whether there are any special requirements for the item. Consult the SADMERC Web site product listing or your DMERC, as appropriate, on these topics.