CMS Sets September Test Deadline for Power Chairs and Scooters
BALTIMORE--CMS has set a Sept. 1 deadline for manufacturers to submit power chair and scooter test results that will be used to match products with billing codes and develop fees--all before 49 new mobility codes become effective Jan. 1, 2006.

"The sooner [testing] is done, the better," Joel Kaiser of CMS' division of community and post-acute care said at a CMS Open Door Forum held Thursday. "I encourage [manufacturers] to start right away."

CMS released the new codes for power chairs and scooters earlier this month as part of its overall initiative to revamp the Medicare mobility benefit. The agency is requiring products to be tested at some 30-35 facilities certified worldwide by RESNA (Rehabilitation Engineering Society of North America). Manufacturers must submit test results and a completed application for coding verification to the SADMERC (Statistical Analysis Durable Medical Equipment Regional Carrier) by the Sept. 1 deadline.

CMS said it hopes to have sufficient data by the September date to establish fees. But if it doesn't, "payment may be made on the basis of individual consideration of each claim until the necessary information is obtained," according to an agency statement.

CMS' initiative to revise the power chair billing codes represents the first update in 12 years, Kaiser explained, adding that "there has been major evolution in the technology since 1993. Obviously, something needed to be done."

For more information, visit the "Highlights" section of CMS' DMEPOS Web site at www.cms.hhs.gov/suppliers/dmepos. Further information, including a coding verification application, is available on the SADMERC Web site by clicking here.

CMS Redraws Medicare Carrier Map
BALTIMORE--Medicare has announced new carrier jurisdictions, including those for the four DMERCs, to be used when it puts DME claims processing business up for bid next month.

Part of an overall change in Medicare's claims processing program, the reconfiguration is designed to "balance the allocations of workloads, promote competition, account for integration of claims-processing activities and mitigate the risk to the Medicare program during the transition to the new contractors," according to a CMS statement issued last Thursday.

As mandated by the Medicare Modernization Act, CMS must put all fee-for-service claims processing business up for bid--including Part A, Part B, DME and home health and hospice--and award all contracts by 2011. The new claims payment contractors will be called Medicare Administrative Contractors, or MACs. The agency will award four "specialty" DME MACs, 15 primary MACs and four other specialty MACs serving home health and hospice providers.

Next month, the agency will begin the contractor reform process with the DMERCs, and will issue a DME MAC request for proposal. Winners, to be chosen by December, will cover geographic areas that resemble current DMERC regions, but with several realignments. For example, CMS has switched Maryland and the District of Columbia from Region B to Region A, and Virginia and West Virginia from Region B to Region C. The new MAC jurisdictions include:

Region A--Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.

Region B--Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.

Region C--Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia and West Virginia.

Region D--Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington and Wyoming.

CMS said the DME carrier regions were altered to coordinate with new regions for handling Part A and B claims, and that an analysis shows the changes will "affect a relatively small percentage of providers and beneficiaries in these areas." Currently, Part A and B carriers operate in 51 overlapping jurisdictions. In the coming years, CMS plans to award contracts for MACs that will process both Part A and B claims within only 15 jurisdictions.

More information, including a map of all new MAC jurisdictions and a timeline for contract awards, is available at www.cms.hhs.gov/medicarereform/contractingreform.

CMS Sets July Deadline for Electronic Claims Compliance
BALTIMORE--A few exceptions aside, CMS will no longer process paper claims starting July 5.

According to a Change Request transmittal posted in January, all paper claims Medicare carriers receive will appear on a report. "Providers will have to submit an explanation of why they are submitting this way," a CMS spokesperson said. "If they cannot justify a reason, their claims will be denied."

Even though CMS is enforcing the electronic claims requirement, the agency has not yet set a final deadline for enforcing HIPAA-compliant code sets. Since CMS' original deadline for filing HIPAA-compliant claims a year-and-a-half ago, about 17 percent of all providers who file are still non-compliant, the spokesperson said. He added, though, that non-compliant providers submit only a small fraction--less than 1 percent--of all the claims Medicare processes. "We're just trying to get everyone else onboard," he said.

Part of HIPAA's Administrative Simplification Compliance Act, small providers and those who meet other exception criteria can continue to submit paper claims. To view these exceptions, and for more HIPAA information, visit CMS' Web site by clicking here. To view the Change Request posted on the CMS Web site, click here.

AAHomecare Announces Advocacy Priorities
ALEXANDRIA, Va.--Last week, the American Association for Homecare announced its advocacy priorities for 2005. They include:

--Protect HME and home health from further cuts in any legislation passed during 2005.
--Counter competitive bidding in light of recent reimbursement cuts, and expand the focus on the CMS program advisory oversight committee (PAOC) on competitive bidding.
--Protect the dispensing fee amount of $57 per monthly supply for inhalation drug therapies.
--Maintain the market basket increase and rural add-on for home health services and oppose co-payments for home health.
--Change the exclusionary rule, which compares Medicare and private charges and, according to the association, could exclude Medicare providers whose charges are considered excessive based on that comparison.
--Preserve current reimbursement for stationary oxygen systems in light of efforts to move to a modality-specific payment model.

The association announced it would tackle additional areas as they emerge. Work in home health will also focus on raising awareness of the home health benefit among the Medicare Payment Advisory Commission, or MedPAC, preserving home health benefits in Medicaid and creating opportunities in the areas of pay-for-performance and telehealth.

For more on association initiatives, see the "AAHomecare Update" in the March issue of HomeCare magazine.

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