Regulatory Updates

State: All

DMEPOS suppliers – Liability Insurance Verifications

Date Posted : 01/27/2023

Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

Liability insurance verifications Suppliers must meet requirements to enroll in the Medicare program as a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier. This includes meeting DMEPOS supplier standards. The DMEPOS supplier standards can be located 42 C.F.R. section 424.57(c). Standard 10 requires all DMEPOS suppliers have comprehensive liability insurance in the amount of at least $300,000 (for each incident) and the insurance must remain in force at all times. Per guidance from the Centers for Medicare and Medicaid Services (CMS) and in an effort to protect the Medicare trust fund by ensuring supplier standards are met, the NPEAST DMEPOS contractor will contact the insurance agent to verify the policy is active and current with a CMS-855S application submission. Please ensure your insurance agent replies to verification requests in a timely manner to aid in the processing of DMEPOS applications.

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State: All

Hospice – Revisions to Hospice Appendix M of the State Operations Manual

Date Posted : 01/27/2023

Program: Hospice

Revisions to Appendix M and complementary revisions to the CMS Hospice Basic Surveyor Training will equip surveyors from all surveying entities (State Agencies and Accrediting Organizations) to focus on the quality of care and facilitate consistency. • Surveyors who have previously taken the CMS Hospice Basic Surveyor Training will take an abbreviated training that explains the new approach, while all surveyors (State Agencies and Accrediting Organizations) who have not taken an earlier version of the CMS Hospice Basic Surveyor Training will take the full revised training.

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State: All

Medicare Enrollment in PECOS: Faster & Easier Application Process

Date Posted : 01/26/2023

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Critical Care Hospital, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Home Health, Home Infusion Therapy, Hospice, Pharmacy, Renal Dialysis, Sleep

Medicare Enrollment in PECOS: Faster & Easier Application Process — Coming Summer 2023

Submitting and tracking Medicare Enrollment applications in PECOS is about to get easier and faster. Starting this summer, PECOS will have features to better meet your needs. Watch this 2-minute video or read these FAQs to learn more about:

• A single application for multiple enrollments
• Pre-population of data and an application that’s tailored to you
• Enhanced capability to add or delete group members
• Real-time processing checks and status updates
• Re-validation reminders

The PECOS redesign will include a robust Knowledge Base with extensive content to help answer questions about enrollment, how to use all the new features, and much more. We’ll provide you with regular updates on the PECOS redesign over the coming months.

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State: All

Home Oxygen: 3 New Claim Modifiers

Date Posted : 01/5/2023

Date Effective : 01/3/2023

Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

CMS added 3 new modifiers for home oxygen use under national coverage determination (NCD) 240.2 to indicate the appropriate treatment regimen and presence of supporting documentation for each Medicare patient group:

• Section B, Group I: modifier N1
• Section B, Group II: modifier N2
• Section D: modifier N3

Patients under NCD Section B, Group II and Section D have payment and recertification requirements that don’t apply to Group I. The new modifiers are effective January 1, 2023, and will be available in the April 2023 HCPCS code release. Your Medicare Administrative Contractor will provide more details.

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State: All

Telehealth Home Health Services: New G-Codes

Date Posted : 12/29/2022

Date Effective : 01/1/2023

Program: Home Health

Prior to January 1, 2023, data on telecommunications technology used during a 30-day period of care at the patient level was not collected on home health claims. Effective January 1, 2023, Home Health Agencies (HHAs) may begin voluntarily reporting the new telecommunications G-codes on HH claims with HH periods of care that start on or after January 1, 2023. On July 1, 2023, reporting these new codes will become mandatory with HH periods of care that start on or after July 1, 2023.

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State: All

Billing correctly: Power Mobility Devices

Date Posted : 12/15/2022

Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

The Power Mobility Devices booklet explains how to properly document and bill for power mobility devices (PMDs). Follow these steps to bill for PMDs:

• Obtain the Standard Written Order (SWO)
• Make a prior authorization request
• Complete a home assessment
• Keep the following documents: SWO, face-to-face visit supporting documents, written home assessment report, and proof of delivery
• Review all information to avoid improper payments

An Office of Inspector General report stated that Medicare improperly paid claims for PMD repairs. To properly bill for PMD repairs:

• Show repairs are reasonable, necessary, or meet the requirements
• Document labor time adequately
• Show that DMEPOS suppliers must provide repair warrantees
• Specify that wheelchair repair costs can’t exceed a certain amount over a device’s 5-year lifetime

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