Frequently Asked Questions:

Question:

Can a supplier make up their own Advance Beneficiary Notice Form (ABN)?
Answer: No. The appropriate form to use is the Office of Management and Budget (OMB) form number CMS-R-131-G [PDF]. This is located on the Forms section of CMS’ web site. http://www.cms.hhs.gov/BNI/Downloads/CMSR131L.pdf
   
Question:   What will happen if an assigned claim does not reach the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) within one year?
Answer: Medicare assigned claims must be filed within one year from the service date or the payment will be reduced by 10 percent timely filing fee.
   
Question: Are the doctors’ UPINs being replaced with their NPIs and if so, how do I get their NPI numbers?
Answer: Yes, UPINs are being replaced with the medical professionals’ NPIs. You can locate the needed NPI in the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do or by contacting your health care partners and asking for their NPIs.
   
Question: Is the 90-day grace period still in effect for old HCPCS codes?
Answer: The Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules require suppliers to use the medical code set (HCPCS codes) that is valid at the time the service is rendered. Therefore, effective January 1, 2005, HCPCS codes no longer have a 90-day grace period and will be denied as incorrect coding.
   
Question: Which items require spanned dates?
Answer: The items below require date spans when submitting claims to the Durable Medical Equipment Medicare Approved Contractor:
  • Diabetic testing supplies (test strips, lancets, and calibration chips)
  • Continuous passive motion device (CPM)
  • Parenteral and enteral nutrition & admin kits
  • External infusion pump supplies
Note: Do not span dates for any other durable medical equipment claims.
   
Question: Do we have to have an original "pen and ink" signature on prescriptions and CMNs?
Answer: Written orders may take the form of a photocopy, facsimile image, electronically maintained, or original "pen and ink" document. (Reference: CMS Manual System, Pub. 100-8, Medicare Program Integrity Manual, Chapter 3, section 3.4.1.1.B.)
   
Question: How do we obtain same or similar equipment on file for a beneficiary?
Answer: To obtain same or similar equipment on file, contact the Jurisdiction C DME MAC customer service department at 866.270.4909 with the beneficiary on the line. The beneficiary must provide verbal authorization before equipment on file may be released on a pre-claim basis. If your claim has already denied for same or similar, the equipment on file may be released without consent from the beneficiary once supplier disclosure validation has been completed.  All other DME MACs will give you this information without the beneficiary being on the line:  Noridian, Region D Supplier Contact Center is 1-866-243-7272, Administar Federal Inc., Region B phone number is 1-877-299-7900 and NHIC, Region A phone number is 866-590-6731.
   
Question: Where can I get the CMS-855 application located?
Answer: The CMS-855S is a form for DME suppliers to obtain a Medicare supplier number and may be accessed at www.cms.hhs.gov/cmsforms. The National Supplier Clearinghouse also offers “Helpful Hints” for completing the CMS-855 form.  I strongly recommend using the helpful hints.

 

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