December 17, 2015 A Collaborative Webinar Power Mobility Devices

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Presenters

• Kari O’Hara – NHIC, Corp. – Jurisdiction A

• Tamara Hall – National Government Services – Jurisdiction B

• Michael Hanna – CGS Administrators, LLC – Jurisdiction C

• Diana Duchscherer – Noridian Healthcare Solutions – Jurisdiction D

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Webinar Access

• All registrants received an email from: Medicare Webinar by National Government Services [GoToWebinar.Notifications@citrixonline.com] – Click on the link within the email to join the web

presentation – Using your telephone, dial into the conference call

using the number and access code provided in the email

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Today’s PowerPoint Presentation • Once you are connected to the webinar,

select Handouts – Select the PowerPoint to

download the presentation

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Audio

• Once you are connected to the audio, the PIN displays – Input the PIN on your screen

into your telephone – Dial in number and PIN are

unique for each attendee

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Disclaimer The Medicare contractors have produced this material as an informational reference for providers furnishing services in our contract jurisdictions. The Medicare contractors employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the Centers for Medicare & Medicaid Services (CMS) Web site at http://www.cms.gov.

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Acronyms ABN – Advance Beneficiary Notice of Noncoverage ADMC – Advance Determination of Medicare Coverage ADR – additional documentation request CMS – Centers for Medicare & Medicaid Services DME – durable medical equipment DMEPOS – durable medical equipment, prosthetics, orthotics, and supplies F2F – face-to-face HCPCS – Healthcare Common Procedure Coding System HICN – Health Insurance Claim Number LCD – local coverage determination LCMP – licensed/certified medical professional MAC – Medicare Administrative Contractor

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Acronyms MRADL – mobility-related activities of daily living MSRP – manufacturer's suggested retail price PA – policy article PAR – prior authorization request PMD – power mobility device POV – power operated vehicle RUL – reasonable useful lifetime UTN – unique tracking number

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Agenda

• PMD Base Coverage Criteria • PMD Documentation Requirements • Advance Determination of Medicare

Coverage • Prior Authorization Request Demonstration • Advance Beneficiary Notice of Noncoverage

and Upgrades • Repairs and Replacements

PMD Coverage Criteria

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General Coverage Criteria

• The beneficiary has a mobility limitation that significantly impairs his/her ability to participate in one or more MRADLs such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home. A mobility limitation is one that: – Prevents the beneficiary from accomplishing an MRADL

entirely, or – Places the beneficiary at reasonably determined

heightened risk of morbidity or mortality secondary to the attempts to perform an MRADL; or

– Prevents the beneficiary from completing an MRADL within a reasonable time frame.

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General Coverage Criteria

• The beneficiary’s mobility limitation cannot be sufficiently and safely resolved by the use of an appropriately fitted cane or walker.

• The beneficiary does not have sufficient upper extremity function to self-propel an optimally-configured manual wheelchair in the home to perform MRADLs during a typical day. – Limitations of strength, endurance, range of motion, or

coordination, presence of pain, or deformity or absence of one or both upper extremities are relevant to the assessment of upper extremity function.

– An optimally-configured manual wheelchair is one with an appropriate wheelbase, device weight, seating options, and other appropriate nonpowered accessories.

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POV Additional Coverage Criteria • The beneficiary is able to:

– Safely transfer to and from a POV, and – Operate the tiller steering system, and – Maintain postural stability and position while operating

the POV in the home, and • The beneficiary’s mental capabilities (e.g.,

cognition, judgment) and physical capabilities (e.g., vision) are sufficient for safe mobility using a POV in the home, and

• The beneficiary’s home provides adequate access between rooms, maneuvering space, and surfaces for the operation of the POV that is provided.

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POV Additional Coverage Criteria • The beneficiary’s weight is less than or equal to the

weight capacity of the POV that is provided and greater than or equal to 95% of the weight capacity of the next lower weight class POV – i.e., a heavy duty POV is covered for a beneficiary weighing 285 – 450 pounds, and

• Use of a POV will significantly improve the beneficiary’s ability to participate in MRADLs and the beneficiary will use it in the home, and

• The beneficiary has not expressed an unwillingness to use a POV in the home.

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PWC Additional Coverage Criteria • The beneficiary has the mental and physical

capabilities to safely operate the PWC that is provided; or

• If the beneficiary is unable to safely operate the PWC, the beneficiary has a caregiver who is unable to adequately propel an optimally configured manual wheelchair, but is available, willing, and able to safely operate the PWC that is provided

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PWC Additional Coverage Criteria • The beneficiary’s weight is less than or equal to the weight

capacity of the PWC that is provided and greater than or equal to 95% of the weight capacity of the next lower weight class PWC – i.e., a heavy duty PWC is covered for a beneficiary weighing 285 – 450 pounds, and

• The beneficiary’s home provides adequate access between rooms, maneuvering space, and surfaces for the operation of the PWC that is provided, and

• Use of a PWC will significantly improve the beneficiary’s ability to participate in MRADLs and the beneficiary will use it in the home. For beneficiaries with severe cognitive and/or physical impairments, participation in MRADLs may require the assistance of a caregiver, and

• The beneficiary has not expressed an unwillingness to use a PWC in the home.

Documentation Requirements Face-to-Face Examination

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F2F Examination

• F2F examination has two components: 1. Decision component—An in-person visit between

the beneficiary and the ordering physician to document the decision to order a PMD; and,

2. Medical evaluation component—A medical examination to document the beneficiary’s mobility and functional condition.

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F2F Examination

• The F2F examination of the beneficiary must occur prior to the clinician ordering a PMD and the supplier must receive this report within 45 days following the evaluation.

• The exception to this rule is if the examination is performed during a hospital or nursing home stay. In this instance, the supplier must receive the report of the evaluation within 45 days after discharge.

• The PMD 7-element order must be in writing and signed and dated by the physician or treating practitioner who performed the F2F examination.

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F2F Examination

• The F2F examination should be tailored to the individual beneficiary and the medical condition(s) causing mobility difficulty.

• The physical examination should focus on the systems causing the mobility deficits.

• There should be statements indicating why other mobility equipment (cane, walker, manual wheelchair) will not meet the beneficiary’s needs.

• The F2F examination should be written in detail in the format used for other entries.

• A date stamp or equivalent is required by the supplier indicating date of receipt.

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Additional F2F Instructions

• The F2F exam does not necessarily have to occur at a single visit and is not always performed by a single individual.

• The physician may refer the beneficiary to a LCMP such as a physical or occupational therapist.

• The LCMP may not be an employee of the supplier or have a financial relationship with the supplier.

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Subjective vs. Objective

• When a Medicare contractor looks at supporting documentation, they are looking for objective, measurable information concerning the beneficiary’s clinical condition.

• Subjective statements are less informative because they are not measurable and therefore are more open to individual interpretation.

• The beneficiary’s condition should be described with enough detail that the reviewer can apply the principles of the LCD and make an individual determination that the beneficiary needs the item prescribed to safely perform MRADLs within the home.

Documentation Requirements Seven-Element Order

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Seven-Element Order Requirements • A seven-element order is required for all

PMDs and it must include the following information: – Beneficiary’s name – Description of the item that is ordered – Date of completion of the F2F examination – Pertinent diagnoses/conditions that relate to the

need for the power mobility device – Length of need – Physician’s signature – Signature date

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Additional seven-Element Order Instructions • If the supplier receives the seven-element

order that does not contain the elements specified on the previous slide, the supplier must clarify this by obtaining a new seven-element order.

• However, the new/revised seven-element order must be signed and dated by the treating physician and received by the supplier prior to the DPD and before the PMD is delivered to the beneficiary.

• This revised order must also be received within 45 days of the F2F examination.

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Additional Seven-Element Order Instructions • A date stamp or equivalent must be used to

document the receipt date by the supplier. • The seven-element order cannot be dated

before the F2F examination. • Podiatrists cannot prescribe any type of

power mobility device. – PMDs prescribed by a podiatrist will be denied as

noncovered

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What is the F2F Examination Date? • Face-to-Face Examination Date on Seven-

Element Order for Power Mobility Devices Scenarios article available on DME MACs websites

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Common Scenario

• The ordering physician completes the decision component of the F2F examination at the initial in-person encounter with the beneficiary. The beneficiary is referred to another LCMP who has experience and training in mobility evaluations, to perform all or a portion of the medical evaluation of the F2F examination. The F2F examination date listed on the seven-element order is the date the physician signed, dated and indicated concurrence or disagreement with the LCMP mobility evaluation.

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Common Scenario

• The F2F examination has been completed, but the physician later identifies that there is information not properly documented in the medical record about the beneficiary which is necessary to support coverage criteria for a PMD. If the physician provides an amendment, correction or addenda to the F2F examination with information that arose from the previously performed F2F examination, the F2F examination date does not change on the seven-element order. The amendment, correction or addenda to the F2F examination should appear in the beneficiary’s medical record.

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Common Scenario

• The F2F examination has been completed, but the physician later identifies that there is information that was not addressed during the F2F examination which is necessary to support coverage criteria for a PMD. The physician must provide this new information in the medical record but since this was not a part of the original F2F, this does require a new in-person visit for the beneficiary with the physician. This new in-person visit date becomes the F2F date on the seven-element order.

Amendments, Corrections or Addenda

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Amendments, Corrections or Addenda • Amendments, corrections or addenda must:

– Clearly and permanently identify any amendment, correction or delayed entry as such, and

– Clearly indicate the date and author of any amendment, correction or delayed entry, and

– Clearly identify all original content, without deletion.

• Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.5 – http://www.cms.gov/Regulations-and-

Guidance/Guidance/Manuals/Downloads/pim83c03.pdf

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Paper Medical Records

• Corrections – Use a single line strike through so that the original

content is still readable – Author of the alteration must sign and date the

revision

• Amendments or delayed entries – Clearly signed and dated upon entry into the record

• Amendments or delayed entries to paper records may be initialed and dated if the medical record contains evidence associating the provider’s initials with their name

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Electronic Health Records

• Distinctly identify any amendment, correction or delayed entry, and

• Provide a reliable means to clearly identify the original content, the modified content, and the date and authorship of each modification of the record.

Documentation Requirements Detailed Product Description

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PMD DPD

• Once the supplier has finalized the specific PMD that will be provided to the beneficiary, the supplier must prepare a written document (termed a DPD) that lists: – The specific base (HCPCS code or manufacturer

name/model) and all options and accessories that will be separately billed to Medicare.

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DPD

• The order date must be on the DPD • The physician must sign and date this DPD and the

supplier must receive it prior to delivery of the PWC or POV

• A date stamp or equivalent must be used to document the receipt date by the supplier

Note: This DPD must comply with the requirements for a detailed written order as outlined in the supplier manual and Medicare Program Integrity Manual, Chapter 5.

Documentation Requirements Home Assessment

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PMD Home Assessment

• Prior to, or at the time of delivery of a PMD, the supplier must perform an onsite evaluation of the beneficiary’s home to verify that the beneficiary can adequately maneuver the device considering physical layout. There must be a written report of this evaluation available on request.

• If ruling out a POV, the documentation should include notations of doorway width, corridor width, room size, etc. to indicate how the supplier came to the conclusion that the maneuvering space was insufficient for the use of a POV.

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PMD Home Assessment

• A PMD will be denied if: – An assessment of the home environment does not

support that the maneuvering space in the home is inadequate for PMD use.

Advance Determination of Medicare Coverage

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ADMC

• Determination prior to delivery • Voluntary • Nationwide • Except PAR states for codes subject to

demonstration • Able to resubmit once in a six month period

– Second ADMC request must be received within 6 months of the date of the letter from the first denial

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ADMC PMD HCPCS Codes

• Group 2, 3 or 5 single or multiple power option wheelchair – K0835–K0843 – K0856–K0864 – K0890–K0891

• Group 3 no power option wheelchair – K0848–K0855

• With alternative drive control interface

• Custom wheelchair – K0013

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ADMC Process

• Submit request to appropriate jurisdiction for review

• Submit all required documentation • DME MAC determines if equipment is

reasonable and necessary – Within 30 calendar days – Written decision

• Eligible base submitted – Options and accessories ordered will be eligible

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ADMC Rejections

• Not a denial • Able to submit another ADMC • No time limit

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ADMC Decisions

• Negative Decision – Resubmit once in six months – Additional medical documentation received – If submit claim

• Normal appeals process

• Affirmative Decision – Valid for six months from date of determination

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ADMC Resources

• Jurisdiction A – http://www.medicarenhic.com/dme/contactsclaimssubmission.

aspx • Jurisdiction B

– https://ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/Supplier-Manual/chapter%209%20-%20advance%20determination%20of%20medicare%20coverage/admc%20determination

• Jurisdiction C – http://cgsmedicare.com/jc/mr/admc.html

• Jurisdiction D – https://med.noridianmedicare.com/web/jddme/cert-

reviews/mr/admc

Prior Authorization Request Demonstration

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PAR

• 25% reduction in payment if no PAR • Unlimited resubmissions • Extended to August 31, 2018

Jurisdiction A Jurisdiction B Jurisdiction C Jurisdiction D Maryland Illinois Florida Arizona

New Jersey Indiana Georgia California New York Kentucky Louisiana Missouri

Pennsylvania Michigan North Carolina Washington Ohio Tennessee Texas

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PMD PAR HCPCS Codes

• What PMD items are affected? – All power operated vehicles (K0800–K0802 and K0812) – All standard power wheelchairs (K0813 thru K0829) – All Group 2 complex rehabilitative power wheelchairs

(K0835 thru K0843) – All Group 3 complex rehabilitative power wheelchairs

without power options (K0848 thru K0855) – Pediatric power wheelchairs (K0890 and K0891) – Miscellaneous power wheelchairs (K0898)

• Exclusions: – Group 3 complex rehabilitative power wheelchairs with

power options (K0856 thru K0864)

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PAR Process

• Submit request to appropriate jurisdiction for review

• Submit all required documentation. • DME MAC determines if equipment is

reasonable and necessary – Within 10 calendar days – initial request – Within 20 calendar days – subsequent requests – Written decision

• Review limited to the base code only

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Nonaffirmed PAR Decision

• Detailed determination letter – UTN

• Next step – Resubmit PAR – Submit claim for denial

• Include UTN • Appeal rights engaged • Submit to secondary insurance

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Affirmed PAR Decision

• Decision letter – UTN

• Follows the beneficiary • Next step

– Home assessment – Deliver equipment (document) – Submit claim with UTN

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PAR Not Submitted

• Stopped for review – ADR letter sent

• Payment reduction will apply – Exception – Base subject to competitive bid

• Competitive bid supplier paid at single payment amount

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PAR Resources

• Jurisdiction A – http://www.medicarenhic.com/dme/pmddemo.aspx

• Jurisdiction B – https://ngsmedicare.com/ngs/portal/ngsmedicare/newngs/hom

e-lob/pages/complianceandaudits/medical-review/medical-review-focus-areas/dme_pmd%20par

• Jurisdiction C – http://cgsmedicare.com/jc/mr/prior_auth.html

• Jurisdiction D – https://med.noridianmedicare.com/web/jddme/cert-

reviews/mr/prior-authorization

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Determining ADMC or PAR

Resides in PAR demonstration state?

Yes – Is HCPCS subject to PAR?

Yes – Submit PAR

No – Is HCPCS eligible for ADMC?

Yes – Submit ADMC

No – Submit claim as normal

No – Is HCPCS eligible for ADMC?

Yes –Able to submit ADMC

No – Submit claim as normal

Advance Beneficiary Notice of Noncoverage

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ABNs

• Situations requiring an ABN (not all inclusive): – Not medically reasonable and necessary – Prohibited, unsolicited telephone contacts – No supplier number – ADMC denial – Noncontract suppliers providing a competitively bid item

for a competitive bidding area

• Allows beneficiary to make informed decision • Protects supplier from liability • Properly execute prior to delivery of item(s)

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ABN Completion Reminders • Blank (C) Identification Number:

– Enter an identification number for the beneficiary that helps to link the notice with a related claim when applicable. The beneficiary’s Medicare number or HICN is not permitted.

– Not a required field • Blank (D):

– Explain what item(s) is not medically necessary • Blank (E) Reason Medicare May Not Pay:

– Explain a valid reason why the item(s) is not covered by Medicare • Blank (F) Cost:

– Estimated cost of what the beneficiary will have to pay out of pocket for the item(s)

• Valid once beneficiary/designee signs and dates ABN. • Valid for one year from signature date.

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Modifier Usage with ABNs

• GA: Waiver of liability statement issued as required by payer policy, individual case – Valid ABN on file

• GZ: Item or service expected to be denied as not reasonable and necessary – No ABN on file or ABN is invalid/incomplete

• GY: Noncovered – May execute an ABN as a voluntary notice of

noncoverage

GA or GZ and GY never reported on same claim line

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GA or GZ Modifier

• Expectation of a medical necessity denial – All documentation meets requirements per medical

policy however, medical necessity not established for PMD beneficiary receiving

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Upgrades: Charging the Beneficiary • Usage of the GK modifier

– Actual item/service ordered by physician, item associated with GA or GZ modifier

• Line 1 K0813RRKHGA Billed Amount $350.00 – Will result in PR-50 denial, with $350.00 payment

responsibility

• Line 2 K0823RRKHKXGK Billed Amount $600.00 – Will process for payment

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Upgrades: Not Charging the Beneficiary • Usage of the GK modifier

– Actual item/service ordered by physician, item associated with GA or GZ modifier

• Line 1 K0813RRKHGZ Billed Amount $350.00 – Will result in CO-50 denial, with $350.00 payment

responsibility

• Line 2 K0823RRKHKXGK Billed Amount $600.00 – Will process for payment

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Upgrades: Not Charging the Beneficiary or Medicare • Usage of the GL modifier

– Medically unnecessary upgrade provided instead of standard item, no charge, no advance beneficiary notice (ABN)

• Line 1 K0813RRKHKXGL – Will process for payment

• Note Segment – Specific make and model of the item actually

furnished (the upgrade item) and the reason behind the upgrade.

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EY Modifier

• PMDs dispensed and/or billed that do not meet the prescription requirements must be submitted with an EY modifier added to each affected HCPCS code.

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GY Modifier

• Statutorily excluded item/service • LCD or PA advises to use in specific situations,

including but not limited to – seven-element order invalid or not received within 45

days of F2F examination – F2F examination documentation not received prior to

delivery of PMD – PMD delivered without a valid DPD on file – PMD being used solely outside of the home – PWC with a seat elevator (K0830, K0831) provided

• Should not report the GY modifier with the KX, GA or GZ modifier

Replacement

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Replacement – Basic Payment Rules • Substitute an item for another that is

broken, inefficient, lost or no longer working or yielding what is expected

• Replacement of PMD may occur in cases of loss, irreparable damage, or a change in beneficiary’s condition – Loss/stolen – Irreparable Damage

• Specific accident or a natural disaster

• Beneficiary’s condition changes to necessitate a different type of equipment

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Replacement – Basic Payment Rules • Replacement of PMD may occur in cases of

irreparable wear after the reasonable useful lifetime has expired – Irreparable Wear

• Deterioration sustained from day-to-day usage over time

• Replacement due to irreparable wear takes into consideration the reasonable useful lifetime of the equipment

• Note: Replacement due to wear and tear before the reasonable useful lifetime is not covered

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Replacement Documentation

Prior to five year RUL • Loss or irreparable

damage • New DPD • New F2F examination

is not required – Exception of items

subject to the Affordable Care Act, section 6407

• All other applicable documentation

After five year RUL • New F2F examination • New seven-element

order • New DPD • All other applicable

documentation

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Replacement – Basic Payment Rules • Useful Lifetime

– In no case can it be less than five years – Computation is based on when the PMD was

delivered

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Replacement Modifier

• RA: Replacement of a DME item – Denotes instances where an item is furnished as a

replacement for the same item which has been lost, stolen or irreparably damaged

• RA only needs to be appended to first month claim for rental items

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Documentation Requirements for Replacements • When billing for replacement PMDs, the

following documentation (not all inclusive) must be kept on file and made available upon request: – Reason for replacement – New Order – Medical records – Police reports – Written explanation from the beneficiary

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Narrative Requirements for Replacement • There must be specific information notated in

the NTE 2300 or 2400 segments of the electronic claim in order for Medicare to consider coverage of a replacement item. This includes all of the following information: – The description of the beneficiary owned PMD that is

being replaced – The HCPCS code of the PMD – The date of purchase of the PMD – Reason for replacement

• Example: “RPL K0823 PMD PUR 110506 BBR”

Repairs

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Repairs – Basic Payment Rules

• To fix or mend and to put the equipment back in good condition after damage or wear

• Covered when necessary to make the PMD serviceable

• Repairs may be covered on PMDs obtained by a beneficiary prior to Part B enrollment

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Repairs – Basic Payment Rules

• Repairs are covered up to the cost of replacement for medically necessary equipment owned by the beneficiary

• The beneficiary is expected to perform routine maintenance such as testing, cleaning, regulating, and checking the equipment – If more extensive maintenance needs to be performed

by authorized technicians, or if the maintenance requires the use of specialized testing equipment that is not normally available to the beneficiary, then the maintenance is covered as a repair for owned equipment

• A new physician’s order is not required for repairs

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Repairs – Basic Payment Rules

• Repairs are not covered during rental periods – Capped Rentals, Frequently Serviced,

Inexpensive/Routinely Purchased and Oxygen and Oxygen Equipment

• Payment for parts and labor that are covered under a manufacturer or supplier warranty will not be included in the payment for maintenance and repairs

• Not covered for previously denied equipment • No Medicare payment for travel time or

equipment pick-up and/or delivery/set-up • Any Medicare enrolled supplier can perform

repairs

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Standard Documentation Language Revision – Joint DME MAC Publication • In the case of repairs to a beneficiary-owned

DMEPOS item, if Medicare paid for the PMD initially, medical necessity for the PMD has been established

• With respect to Medicare reimbursement for the repair, there are two documentation requirements: – The treating physician must document that the PMD

being repaired continues to be reasonable and necessary; and

– Either the treating physician or the supplier must document that the repair itself is reasonable and necessary

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Standard Documentation Language Revision – Joint DME MAC Publication • The supplier must maintain detailed records

describing the need for and nature of all repairs including a detailed explanation of the justification for any component or part replaced as well as the labor time to restore the item to its functionality

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Repairs – Coding and Modifiers

• K0739 – Repair or nonroutine service for durable medical equipment other than oxygen requiring the skill of a technician, labor component, per 15 minutes

• One unit of service = 15 minutes • Claims for labor must include narrative

information itemizing: – The nature and medical necessity for each repair – The time taken for each repair

• Certain common repairs have standardized labor times

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Repairs – Coding and Modifiers

• K0108 billed as replacement part incident to repair – K0108 – Wheelchair component or accessory, not

otherwise specified – Claim must include:

• Product Name – The brand name can be abbreviated by using just the first

five letters • Make/Model of Item

– Do not abbreviate the model/part number • MSRP • Example: RPL toggle MFR PRIDE MD FRMASMB272

MSRP 250 00 – If multiple miscellaneous accessories are provided,

each should be billed on a separate claim line using code K0108

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Repairs – Coding and Modifiers

• K0462 – temporary replacement for patient-owned equipment being repaired, any type – Requirements

• Appropriate complete item must be provided, or • Swapping out individual components

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Repairs – Coding and Modifiers

• Claim must include: – Narrative description, manufacturer, and brand

name/number of the PMD being repaired, and – Date of purchase of the PMD being repaired, and – Narrative description, manufacturer, and brand

name/number of the PMD provided as a temporary replacement, and

– Description of what was repaired, and – Explanation of why the repair took longer than

one day

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Repairs – Coding and Modifiers

• All other DME items – E1399 billed as replacement part incident to repair

• E1399 – Durable medical equipment, miscellaneous – Claim must include:

• Product Name – The brand name can be abbreviated by using just the first 5

letters • Make/Model of Item

– Do not abbreviate the model/part number • MSRP • Example: RPL HUMIDIFIER MFR PEGAS MD P35000

MSRP 125 00 – If multiple miscellaneous accessories are provided,

each should be billed on a separate claim line using code E1399

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Repairs – Coding and Modifiers

• RB: Replacement of a part of DMEPOS furnished as part of a repair – Indicates replacement parts of DMEPOS furnished

as part of the service for repairing the DMEPOS item (base equipment/device)

• Be sure to append the RB to any replacement parts as part of a repair in competitive bid areas to prevent unnecessary claim rejections

Resources

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Jurisdiction A Resources

• Website: http://www.medicarenhic.com/dme – LCD – Decision Desktop – Provider Services Portal – Physician’s Corner – Newsletter and Supplier Manual – Educational Events and Offerings – DME MAC A ListServe Subscription – Live Line Chat

• Provider Customer Service – Provider IVR: 866-419-9458 – Provider CSR: 866-590-6731

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Jurisdiction B Resources

• http://www.NGSMedicare.com – Policy

• Medical Policy Center • Policy Education Topics

– Training • Current and past training

events – Compliance & Audits

• Medical Review – Supplier Manual

• NGSConnex: http://www.NGSConnex.com

• Provider Contact Center: 866-590-6727 – Monday–Friday: 8:30 a.m.–

5:30 p.m. ET – Training Closure Time:

Fridays 2:30–4:30 p.m. ET • IVR: 877-299-7900

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Jurisdiction C Resources

• Website: http://www.CGSMedicare.com

• Local Coverage Determinations • http://www.cgsmedicare.com/jc/coverage/LCDinfo.html• myCGS web portal:

http://www.cgsmedicare.com/jc/mycgs/index.html• Jurisdiction C DME Supplier Manual:

http://www.cgsmedicare.com/jc/pubs/supman/index.html• Calendar of Events:

http://www.cgsmedicare.com/jc/education/index.html• Customer Service: 866-270-4909

– Monday through Friday: 7:00 a.m.–5:00 p.m. CST

• IVR Unit: 866-238-9650

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Jurisdiction D Resources • Website: https://med.noridianmedicare.com/web/jddme/

• Local Coverage Determinations: https://med.noridianmedicare.com/web/jddme/policies/lcd

• Supplier Manual: https://med.noridianmedicare.com/web/jddme/education/supplier-manual

• Educational Tools: https://med.noridianmedicare.com/web/jddme/education

• Web Portal: https://med.noridianmedicare.com/web/jddme/topics/portal

• Customer Service/IVR/Telephone Reopenings – Monday–Friday 8 a.m.–6 p.m. CT – 877-320-0390

Questions

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