Briefs: CMS: Use new ABN form by Nov. 1

Thursday, August 25, 2011

BALTIMORE - CMS officials during an Open Door Forum in July alerted HME providers of a new ABN form that they must begin using by Nov. 1, 2011. The agency has updated the form, but it has made no "substantive changes," officials said. Access the form at CMS has scheduled the next Open Door Forum for HME on Aug. 17.

Form C is ready

BALTIMORE - CMS has alerted contract suppliers participating in Round 1 of competitive bidding that it must receive their Form Cs for the second quarter no later than July 29. Typically, the form is due within 10 days of the following dates: March 31, June 30, Sept. 30 and Dec. 31. The form details what items contracts suppliers have provided to beneficiaries under competitive bidding. For more information, go to

GAO to CMS: Fully implement fraud tools

WASHINGTON - CMS needs to do a better job using the tools it has already implemented to detect fraud, according to a recent Government Accountability Office (GAO) report. CMS is using the Integrated Data Repository (IDR) and One Program Integrity (One PI) to, for example, detect duplicate claims, but the agency has not incorporated all data into IDR as planned and has not taken steps to ensure widespread use of One PI to enhance efforts, the GAO states. Additionally, CMS is not yet in a position to identify, measure and track benefits realized from using the systems, the GAO states. The GAO recommends that CMS take steps to finalize plans and schedules for fully implementing and expanding the use of the systems. CMS concurred.

CMS wrongly denying claims

BALTIMORE - A system glitch at the DME MACs has meant some providers are receiving denials due to their eligibility status. "It looks as if when they uploaded files from the accreditors there is some sort of problem with section B of the 855 form," said Walt Gorski, vice president of government affairs for AAHomecare. Section B is where providers indicate what products they provide and are accredited to provide. CMS has indicated it is aware of the problem and is working to fix it. At press time, it was unknown how the erroneously denied claims would be addressed.

MK Battery sweetens pot for Power for Funding 2011

ATLANTA - MK Battery announced July 12 that it will match sponsorships to the Power for Funding event at Medtrade up to $50,000. The battery manufacturer, which is sponsoring the event with Medtrade, has already contributed $50,000 toward underwriting the event and making donations to AAHomecare, NCART and NRRTS. Sponsorship opportunities are available at levels ranging from $1,000 to $25,000. Net proceeds go to the three organizations. In addition to presenting checks to AAHomecare, NCART and NRRTS, the event will feature hors d'oeuvres and refreshments, music, a slideshow of nostalgic images and the presentation of the HME Excellence Awards by HME News. Tickets to the event, Oct. 25 from 5:30 to 8:30 p.m. at the Omni Hotel, are available to all providers. Contact Dennis Sharpe, for more information.

Officials testify on improper claims

WASHINGTON - The HME industry did not escape scrutiny when a House Subcommittee held a hearing July 28 on improper Medicare payments. Officials from the Office of Inspector General, CMS and the Government Accountability Office gave testimony on what contributed to the government paying out $47.9 billion in improper payments in 2010. "Some but not all improper payments are the result of fraud," Daniel R. Levinson, OIG's Inspector General told the subcommittee, in prepared remarks. Government officials pointed to power wheelchair claims as an area where there continue to be problems with billing incorrectly or billing for items that are not medically necessary.

MedPAC releases spending report

WASHINGTON - Medicare spending for DME has remained flat for the past 10 years, according to a new report issued by the Medicare Payment Advisory Commission (MedPAC). DME spending has stayed 2% of total Medicare spending from 2000 to 2010, according to the report. Medicare spent the most money on inpatient hospital services in 2010. 

CMS turns off bad edit

BALTIMORE - CMS has instructed all four DME MACs to turn off the B7 edit that has caused claims to deny as if providers were not accredited. The root of the problem: An error in the supplier file information provided to the DME MACs. The DME MACs will reprocess all denied claims, and suppliers don't need to take any action. No date has been set for reactivation of the edit.

Industry to lose champion

WASHINGTON - Rep. Mike Ross, D-Ark., announced July 25 that he would not run for re-election to Congress. Ross, a former HME owner, has worked with the HME industry on competitive bidding and other issues. Ross has indicated he may run for governor in 2014.

Contractor clarifies billing for beds

WASHINGTON - National Government Services, the Jurisdiction B DME MAC, stated in a message last week that it has seen an increase in billing issues for hospital beds with mattresses, hospital beds without mattresses and support surfaces. As a result, the contractor has developed several articles to clarify billing on these items. Key points addressed in the articles include: granting of new capped rental periods for hospital beds, air flotation beds and air-fluidized beds; correct coding for hospital beds with mattresses, group I support mattresses, and group II support mattresses; upgrade billing; use of the KX, GA, and GZ modifiers; and correct billing to avoid the appeals process.

TAHCS has new leader

DALLAS - The Texas Alliance for Home Care Services has tapped provider Kevin Hill as its new president. Hill, owner of CPS Medical in Tyler, Texas, has more than 30 years of experience in the industry. He will replace Barry Johnson, who was recently named the new president of the Accredited Medical Equipment Providers of America.

MESA office struck by lightning

ORLANDO, Fla. - Liz Moran was running the office of the Medical Equipment Suppliers Association (MESA) on a borrowed laptop and iPhone after a lightning strike July 15. Moran, executive director of MESA, said lightening struck the building, damaging electrical and phone lines, and frying computers, modems and other electronic devices. The two-hour electrical storm also dumped 7.5 inches of rain on the area.