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CMS new demonstration project to include Nurse Practitioners as Certifying Physicians for Therapeutic Shoes and Inserts

Effective January 1, 2021 and extending through December 31, 2025, CMS is exercising its authority to allow nurse practitioners to certify that an order for diabetic shoes is required under a new model demonstration for certain states. Under this...

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CMS ABN form updated

CMS has updated the Advance Beneficiary Notice of Noncoverage (ABN) (Form CMS-R-131). Providers can use the new form now, and mandatory use of the form will be on 8/31/2020. The form is valid through 06/30/2023. On or after 8/31/2020, issuing an ABN...

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Continued Need for Supplies

By Carrie Nienberg, RN, Director of Clinical Operations Did you know ongoing continued need isn’t required for urological or ostomy supplies? In the ostomy policy article, under continued need it indicates once initial medical need is established,...

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MACs issue KX Modifier guidance during the PHE

On May 14, 2020 a Joint DME MAC Bulletin Article was published to provide guidance on use of the KX modifier. Use of the KX modifier indicates that specific required documentation is on file in the patient's medical record. CMS' final rule, which was...

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Quick Tip: Proof of Delivery Signature Guidelines during the COVID-19 pandemic

On Friday the DME MACs provided the following update regarding signature guidelines and proof of delivery: CMS is currently reviewing signature guidelines that have been affected by the COVID-19 pandemic.  At this time suppliers should do their...

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New guidance on timing of the 6-month face-to-face encounter and Standard Written Order for PMDs

By Carrie Nienberg, RN, Director of Clinical Operations Currently, Policy Article A52498, revised on 01/01/20, indicates a face-to-face encounter must occur within six months prior to the order date on the Standard Written Order (SWO). If the beneficiary...

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Hospital Beds and Manual Wheelchairs added to RAC Approved Issues

CMS has approved two new topics for the DMEPOS RAC, Performant, to begin reviewing, effective March 1, 2020. Hospital Beds: Medical Necessity and Documentation Requirements Description: Hospital Beds must meet basic coverage criteria whether at...

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CMNs and ABNs are nearing expiration...what do you do?

By Carrie Nienberg, RN Clinical Director CMNs for Oxygen, Pneumatic Compression Devices, Osteogenesis Stimulators, Transcutaneous Electrical Nerve Stimulator (TENS), Seat Lift Mechanisms, External Infusion Pumps, Enteral and Parenteral nutrition,...

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REPAIRS TO BENEFICIARY OWNED PMD AND THE MEDICARE DOCUMENTS REQUIRED

By Kim Turner, RN In 2018, Medicare paid approximately $46.7 million for PMD repairs, including replacement parts. DME suppliers must maintain documentation from the physician or treating practitioner indicating that the power mobility device (PMD)...

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Decoding the Standard Written Order (SWO)

On January, 1 2020, CMS made it effective that only one type of order is needed for DMEPOS claims, in an effort to help reduce supplier and provider burden. As such, the preliminary/dispensing order, Detailed Written Order (DWO), Five Element Order (5EO)/Written...

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