In an early alert memorandum released Nov. 26, HHS' Office of Inspector General notified CMS that some DMEPOS suppliers with outstanding Medicare debt may still be receiving payments by operating companies that are publicly fronted by business associates, family members or other individuals posing as owners. In a random sample of 10 DMEPOS suppliers in Texas that collectively had Medicare debt of $8.5 million during 2005-2006, the OIG found six of the 10 were associated with 15 other suppliers or HHAs that received Medicare payments totaling $58 million during 2002 to 2007. Billing numbers for eight of the 10 were revoked in either 2003 or 2004, and the remaining two went into inactive billing status in 2000 or 2001. Read the OIG report.
A recent review of claims for budesonide has identified problems with the coding and coverage of the inhalation drug, according to the DME MACs. Read the notice on the Noridian Web site.
In a recent clarification on accreditation reported by AAHomecare last week, Palmetto GBA said providers of drugs and pharmaceuticals who also bill for DMEPOS outside of pharmaceuticals must be accredited to obtain or maintain Medicare billing privileges. Pharmacy providers must update their file with the National Supplier Clearinghouse using the CMS-855S enrollment form. If a pharmacy seeks the accreditation exemption, all other products/services must be removed.
Last week CMS released its ICD-10-Clinical Modification/Procedure Coding System Fact Sheet, which gives general information about the International Classification of Diseases, including benefits of adopting the new coding system, structural differences between ICD-9 and ICD-10 and implementation planning recommendations. To order the new fact sheet, go to http://www.cms.hhs.gov/MLNProducts/01_Overview.asp and then scroll to "Related Links Inside CMS" and select "MLN Product Ordering Page."
Noridian Administrative Services, the DME MAC for Jurisdiction D, now offers a lookup tool for fees, including DMEPOS, drug, dispensing and pharmacy supply fees, and parenteral and enteral nutrition fees. View the tool on the Noridian Web site.