CMS Easing DME MAC Requirements

The Centers for Medicare and Medicaid (CMS) is modifying requirements for DME Medicare Administrative Contractors (MACs) by allowing them to accept timely orders and medical documentation, regardless of whether the supplier received the documentation directly from the beneficiary’s eligible practitioner or from a transferring supplier, as long as they meet Medicare requirements.

In a Change Request published on March 24, CMS stated that the reason for the change is that “Industry has suggested that competition may be bolstered and provider burden limited by allowing suppliers to accept medical documentation from other suppliers who previously held responsibility for that beneficiary.”

The change goes into effect April 24.

DME MACs process Medicare Durable Medical Equipment, Orthotics, and Prosthetics (DMEPOS) claims for a defined geographic area or “jurisdiction. The DMEPOS Competitive Bidding Program uses competition among suppliers to improve the effectiveness of the Medicare methodology for setting DMEPOS payment amounts, while ensuring beneficiary access to quality items and services.

In cases where the documentation is not transferred, contractors are being told to continue to require that a new order/documentation be received by the supplier from the treating physician/practitioner.

Contractors also must describe any necessary workload changes in detail, including the rationale for these changes to their Contracting Officer’s Representative and Medical Review Business Function Lead.

In conjunction with the change order, CMS issued an accompanying article that advises a new order is required in the following situations:

  • There is a change in the order for the accessory, supply, drug, and so forth
  • On a regular basis (even if there is no change in the order) only if it is so specified in the documentation section of a particular medical policy
  • When an item is replaced
  • When there is a change in the supplier, if the recipient supplier did not obtain a valid order for the DMEPOS item from the transferring supplier.

CMS does not view this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs that exceed the amounts allotted in your contract, unless and until specifically authorized by the Contracting Officer.

The Health Law Offices of Anthony C. Vitale can assist your DME company with various services including audit representation, DMEPOS credentialing, etc. Feel free to contact us for additional information at 305-358-4500 or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.

 

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