DME MAC Program Manager Update - Workgroup Collaboration

In previous articles, we shared how the Noridian and CGS Program Managers oversee a variety of operational and collaborative workgroups that meet monthly to discuss opportunities for process improvements across the DME MAC jurisdictions. In this update, we are pleased to share our ongoing workgroup activities.

All our workgroups have as a standing agenda the review of CMS Change Request (CRs), during both the draft and final process to ensure that we have a common understanding of the requirements. This collaborative approach helps to ensure that all DME MACs implement the changes consistently.

Below are just a few recent workgroup highlights:

  • Continuous Glucose Monitors - Correct Coding and Billing – On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) published a final rule in the Federal Register that, in part, addressed the classification and payment of continuous glucose monitors (CGMs) under the Medicare Part B benefit for durable medical equipment (DME). This rule expanded the classification of DME to a larger group of CGMs, regardless of whether the CGMs are non-adjunctive (can replace standard blood glucose monitors for treatment decisions) or adjunctive (do not replace standard blood glucose monitors for treatment decisions).

    The DME MAC medical directors published a comprehensive coding and billing article, the claims processing leaders implemented consistent processing, and our Provider Outreach and Education (POE) teams worked together on widespread education.
  • Revisions to National Coverage Determination (NCD) 240.2 (Home Use of Oxygen) and 240.2.2 (Home Oxygen Use for Cluster Headache) – The DME MACs have been and continue to collaborate closely with each other and CMS to bring you education on this change.  We will continue to bring educational updates as the DME MACs are in the process of revising the Oxygen and Oxygen Equipment Local Coverage Determination (L33797) and the related Policy Article (A52514) to reflect the national CMS policy changes to NCD 240.2 and the removal of NCD 240.2.2
  • Elimination of Certificates of Medical Necessity (CMNs) & Durable Medical Equipment Information Forms (DIFs) – This is another significant change where the DME MACs from multiple areas are closely coordinating  updates needed to internal processes, updates to LCDs and corresponding policy articles and education to achieve a successful implementation.
  • The Medical Review (MR) teams worked closely together and with CMS on the Condition of Payment Prior Authorization expansion to include select orthotics and Power Mobility Device (PMD) Power Operated Vehicle (POV) HCPCS codes. POE teams supported MR in our many collaborative educational offerings.
  • The Appeals and MR Workgroups continued their Interrater Reliability Reviews (IRRs) with each other and other review contractors. With multiple contractors performing medical record reviews, it is important for those contractors to have consistent review practices. These successful IRRs cover common review topics and occur frequently throughout the year.
  • The A/B/DME MAC Education Workgroup is comprised of all MACs. The workgroup identifies lessons learned from the Medicare Fee-for-Service (FFS) Improper Payment Data product category error rates and uses that knowledge to enlist the support of prescribing practitioners to reduce error rates related to insufficient documentation in medical records. So far in 2022, three quarterly collaborative webinars (Orthotics, Medical Documentation, and Glucose Monitors and Supplies) were held for close to a total of 1,100 attendees.

 

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