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David McGill Blogger

The Medicare Policy Manual: What You Have to Know (Part 1)

Posted by David McGill | November 30, 2012

As a DMEPOS Supplier, you are responsible for knowing, understanding and complying with Medicare’s requirements. In a world of RAC and ZPIC audits, CERT reports, heightened MAC scrutiny, and PDAC directives, you can lose sight of the broader Medicare forest, focusing instead on the individual acronym trees. As year-end approaches and we start to think about New Year’s resolutions, we thought that a series on the requirements of the Medicare Policy Manual would be instructive. That way, when you resolve to do a better job of operating your business in 2013, you’ll have an easily reviewable primer on Medicare’s requirements.

In the abstract, this seems like it should be simple. (A large undertaking, but at least simple.) After all, surely each DME MAC organizes its Medicare Policy Manual so that it follows the same basic outline and covers the same topics in the same order as the other MACs, right? Of course, the answer to these questions is a resounding, "No." But fear not, we have attempted to bring some order to this chaos by cross-referencing the substantive topics within each MACs manual so that you can find what you need no matter which Region you’re in. So with that, let’s dip our toe in the pool of Medicare knowledge.

Contact Information
(Region A: Chapter 1)
(Region B: Chapter 24)
(Region C: Chapter 15)
(Region D: Appendix)

While the information provided by each MAC varies from Region to Region, there’s lots of useful data in the Contact Information chapter/appendix. For example, in Region A, it lists (1) where you send Redetermination documentation; (2) where you send Reconsideration documentation; (3) ALJ hearings contact information; (4) where you can send comments regarding draft Local Coverage Determinations; and (5) where you can send comments regarding draft LCD Reconsiderations. And this is in no way an exhaustive.

Not every MAC offers this same range of information, but as a starting point for where to go to deal with different Medicare issues, this is it.

Supplier Enrollment
(All Regions: Chapter 2)

We won’t spend lots of time reviewing this chapter because we’re going to operate under the assumption that our readers, by and large, are already enrolled in the Medicare program. But there are two things we want to highlight.

First, for every Region, this is where you get information on the DMEPOS Supplier Standards. (The Supplier Standards are clearly listed in every Manual except Region D’s. In Region D, the Supplier Standards appear under the heading, “NSC Process for Becoming a DME Supplier.”) We recommend that you review the Supplier Standards on a quarterly basis to make sure that you are in line with each and every one.

Second, in each Region this chapter contains a reminder about reporting changes to Medicare. You must report changes to information provided in your original CMS-855S form to Medicare within 30 days of the change occurring. Examples include the addition or cessation of a specialty, product, or service you provide, moving to a new location, and ownership changes. If you fail to comply with these reporting requirements, Medicare can deny your claims, recoup amounts paid, or even revoke your billing number.

Stay tuned next week for Part 2 of The Medicare Policy Manual: What You Have to Know.

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