The jurisdiction a dme mac contract includes a base year and four option years, for an anticipated duration of five years. Suppliers are encouraged to consult the dme mac jurisdiction c supplier manual and the local coverage determinationpolicy article for full and accurate details concerning policies and regulations. The contents of each chapter with hyperlinks to access individual topics is provided below. On november 30, 2011, nhic, the jurisdiction a durable medical equipment medicare administrative contractor dme mac, posted the results of a widespread prepayment probe for lowerlimb prostheses healthcare common procedure coding system hcpcs codes billed with a k3 functional level modifier and componentsadditions provided, which indicated an overall charge denial. The jurisdiction a dme mac will serve approximately 20,000 medicare dmepos suppliers. Effective june 8, 2012, cms will allow coverage for tens use in the treatment of. Iom 1004 medicare claims processing manual, chapter 1 general billing requirements, section 12. Pursuant to the jurisdiction d dme mac supplier manual, before submitting a. Paper claims returned for item 33b aapc knowledge center. The supplier pays the required application fee via. Mac jurisdiction d supplier manual, chapter 3 documentation. Learn about the former contractors in this jurisdiction at archives. Jurisdiction dme macdmerc phone number jurisdiction a national heritage insurance co.
The supplier is to submit the claim in to jurisdiction b where the medicare beneficiary lives most of the year and not to jurisdiction d where the supplier is located or where the beneficiary is temporarily living. Suppliers who receive a notification letter must respond with all documentation within the timeframe published on the letter. The dme mac jurisdiction c cgs jul 1, 2012 the dme mac jurisdiction c insider will contain. Medicare law limits part b payment for durable medical equipment dme dme mac jurisdiction a supplier manual chapter 10 durable dme mac a supplier manual rev. Dme mac jurisdiction c supplier manual chapter 3, and policy article a20195 for additional information. Palmetto gba national supplier clearinghouse dme mac. Ahla medicaremedicaid conference 2012 jana kolarik anderson, partner. The following information may be found in the jurisdiction b dme mac supplier manual, chapter 5 and is consistent with the guidelines provided by the other three dme macs. Monthly fees for services such as internet, data, or cellular phone are not covered. Connecticut, delaware, district of columbia, maine, maryland, massachusetts, new york, new hampshire, new jersey, pennsylvania, rhode island and vermont dme specialty claims p.
Dmepos fee schedule categories chapter 5 cgs medicare. Dme mac a supplier man ual may 2010 refedo0074 version 3. Current dme mac supplier manuals pedorthic footcare. Jurisdiction b, c, d combined council questions ngs medicare. Ahla medicaremedicaid conference 2012 nelson mullins. Since no titration is required, why splitnight study be used to deny the patient a home trial. This jurisdiction comprises nearly 18% of the overall national medicare feeforservice dmepos claims volume. Hha approved medicare claims processing manual cms. The fall 2012 update to the dme supplier manual is now available 10. A healthcare ancillary service under scrutiny aapc. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download medicare benefits pdf download. Supplier documentation chapter 3 spring 2020 dme mac jurisdiction b supplier manual page 2 if the medicare qualifying supplier documentation is older than sevenyears, proof of continued medical necessity of the item or necessity of the repair can be used as the supporting medicare.
May 1, 2016 appendix b coverage and limitations policies. Below is a list of each dme mac and the states and territories they service. Provider services portal invitation djo healthcare solutions. Dme mac jurisdiction c 2012 news archive cgs medicare. All dme suppliers who serve medicare beneficiaries and meet the supplier standards must apply for a. Chapter 8 of the jurisdiction b dme mac supplier manual quick links. Section 106 of this act mandates that, during the period beginning on january 1, 2020 and ending june 30, 2021, the adjustments to the medicare fee schedule amounts for certain durable medical equipment dme based on information from. The dme mac determines the services performed and the allowable amount appropriate in the particularsituation, taking into account any salvage value of the device.
May 3, 2012 mac to process and pay part b claims for dmepos. The steps on how to become an electronic submitter are available in chapter of the jurisdiction b dme mac supplier manual. Corrected icd9cm code descriptions to match those in the current version of the code book. Summary of oig report on dme mac jurisdiction a in late august, 2010, the oig released a report examining whether the dme mac a contractor, nhic corp. Request for refills documentation requirements published in november 2012. Apr 2, 2012 to provide a more efficient way for dme suppliers and medicare contractors to page 2 upclose with the supplier standards, dmepos supplier enrollment fees the requirement to revalidate billing privileges prior to march 23, 2015. The further consolidated appropriations act, 2020 pub.
To enroll as a medicare dme supplier, there are requirements that must be met. Apr 22, 2016 implementation of the award for jurisdiction a durable medical equipment. Visit noridians covid19 page for information and guidance related to covid19 visit the cms current emergencies page for information and updates related to covid19 and to access the accelerated and advanced payments fact sheet to support our suppliers, a covid19 hotline has been established to help with covid19 related inquiries. Lower limb prosthetics claims paid to premier prosthetics and. Medicare claims processing manual, chapter 1 centers for apr 24, 2012 02. Implementation of the award for jurisdiction b durable medical equipment dme. Before you can enter the noridian medicare site, please. National supplier clearinghouse general palmetto gba. The information previously consolidated into supplier manual chapters is now located in the website for improved access to individual topics. This information is not intended to serve as a substitute for the complete dme mac local coverage determination on. General rules dme mac supplier manual by jj,purisdiction, which provides information on. For additional information, refer to the covid19 web page.
Changed references to dmerc region d supplier manual to the current usage. Jb processes ffs medicare dme claims for illinois, indiana, kentucky, michigan, minnesota, ohio and wisconsin. Dme mac jurisdiction c supplier manual, chapter 4 cgs. Jurisdiction b durable medical equipment medicare administrative contractor dme mac council meeting minutes date. William terry including otolaryngologists from providing dme to medicare patients. How institutional providers will pay the medicare enrollment application fee beginning march 25, 2011. Nhic is the jurisdiction a durable medical equipment medicare medical foods for dhcfp. Implementation of the award for jurisdiction a dme mac. Dme mac and b mac jurisdiction is updated annually and posted at. Download a free copy of acrobat reader spring 2020 supplier manual full manual. The dme contractors request for documentation should be from the supplier who billed for the item, rather than from the medical professional who ordered the item. Cms announces updates to chapter 15 of the program integrity manual, 0502 2012.
In this chapter the terms provider and supplier are used as defined in. Cah bills mac supplier bills dme mac servicing that jurisdiction. If you do not agree with any part of the detailed product description, you should contact the supplier to clarify what you want the beneficiary to receive. Must be fully and successfully registered in the national plan and provider enumeration system nppes pecos medicare will only pay for dme if it meets their criteria and conditions, and if both the prescribing provider and the. This includes items such as cpt codes, cdt codes, icd10 and other ub04 codes. Dme mac a supplier manual may 2010 refedo0074 version 3. Medicare as secondary payer can, under no circumstances, pay more than what medicare would have paid as. Moda health medical necessity criteria durable medical equipment dme general policy page 34 approved by the medical director.
Durable medical equipment medicare administrative contractor the dme. Retired the medical pharmacy version and the dme version of this policy and replaced them with this ph version. Chapter 20 national as part of our continual process to improve connex, jurisdiction b durable for additional information regarding ngs connex, suppliers should login to the. Jurisdiction c cgs administrators medicare supplier manual fall 2012 update. The final reason is the most damaging to dme suppliers because there is a lack of ownership in the creation and oversight in most of the documentation they submit. Jurisdiction d dme mac supplier manual chapter 2 supplier enrollment this chapter outlines the requirements that a dme supplier must meet to receive payment in the medicare program. The dme macs process medicare durable medical equipment, orthotics, and prosthetics dmepos claims for a defined geographic area or jurisdiction, servicing suppliers of dmepos. Dme mac jurisdiction a supplier manual chapter 12 nhic, corp. Advance beneficiary notice of noncoverage abn chapter 3 of the jurisdiction b supplier manual. Dme mac jurisdiction c contractor claim for supplementary medical. Advance determination of medicare coverage admc requests refer to the local coverage determinations lcd for manual wheelchairs, jurisdiction b dme mac supplier manual national government dec 14, 2012 national government services is the jurisdiction b durable medical file non lcd specific on the.
282 573 1637 48 1679 1307 1590 278 1475 1293 157 1364 1250 1127 1549 912 1597 1667 1440 1544 65 958 1427 1487 1286 119 332 52 1663 1495 1221 379 82 171 1202 903 322 334 826 129 807