ACT Questions and Answers - May 17, 2017

MAC Satisfaction Indicator (MSI) Survey - Noridian announced that the MAC Satisfaction Indicator Survey also known as the MSI was available for this year. The survey is conducted by the CFI group on behalf of CMS takes approximately 10 minutes to complete, giving suppliers an opportunity to share experiences with the services provided by Noridian. Supplier feedback is important so Noridian encouraged all suppliers to participate. All responses will be kept confidential.

Noridian Medicare Portal (NMP) - Self Service Reopenings - The NMP Self Service Reopenings has expanded to add additional options for suppliers. This functionality allows real-time adjustments for claim corrections.

2017 In-Person Seminars - Noridian announced it's spring in-person seminars, Medicare Step by Step, for Jurisdiction A. The week of June 20, the seminar will be hosted in King of Prussia, PA. Suppliers can customize their seminar training by selecting training topics from either the general or medical policy tracks. Attendees will have the opportunity to hear from the Provider Outreach & Education (POE) staff and the Medical Review staff.

Electronic Supplier Visits (ESV) - An ESV provide individualized one-on-one with education from POE and/or medical review staff. The request form is on the Educational Forms webpage.

Supplier Transition to Exclusion Program (STEP) - The STEP Program is a voluntary educational program offered for hospital beds, Positive Airway Pressure (PAP), oxygen and manual wheelchair suppliers within Jurisdiction A. A Medical Review nurse will provide customized education and resources for each supplier to independently complete self-audits prior to billing in efforts to reduce error rates and increase reimbursement. If a supplier is interested in STEP, an email should be submitted to JAMedicalReview@Noridian.com. The email should include a contact name, direct phone number, the Provider Transaction Access Number (PTAN) and indicate for which policy category the request is being made.

Revised Advance Beneficiary Notice of Noncoverage (ABN) Form - The ABN form CMS R-131, was recently revised by CMS. The new version is 03/2020 and is available in both English and Spanish. There are special guidance instructions included regarding the ABN for use by nonparticipating suppliers. The current version 03/11 and revised version 03/2020 are available for use until June 21, 2017, when only version 03/2020 will be valid. Access the CMS form from the Noridian ABN webpage.

200-Level Webinars - The 200 Level advanced webinar series is a high-level overview of basic coverage criteria. Suppliers attending these webinars should be well-versed in that policy's requirements as these webinars include complex billing/claims scenarios. Suppliers are encouraged to pre-submit suggested scenarios in advance for use in the 200-Level webinars via fax at 701-433-5957.

May/June Webinars - Suppliers are encouraged to visit the Schedule of Events for upcoming May and June webinars.

Medical Review Update - On January 12, 2107, CMS issued a ruling that one Continuous Glucose Monitor (CGM) device has been approved by the FDA and classified as DME. This CGM device is the Dexcom G5 CGM durable receiver and is classified as an inexpensive routinely purchased (IRP) item. For additional information, see the Coding and Coverage - Therapeutic Continuous Glucose Monitors (CGM) DMD article.

Important Portal Reminders - Passwords that are saved in a user's internet browser may prevent login to the portal. Users are encouraged to enter their password each time they are accessing the portal. Inactivity of 30 minutes will automatically time the user out and a prompt will be displayed at top of page offering an extension to remain logged in. Users should always sign out when finished; otherwise, the NMP requires a user to wait three (3) hours before logging in again. Accounts are disabled after 60 days of inactivity. To reactivate the account, users must contact NMP Support. Accounts are deleted after 90 days of inactivity. When an account is deleted, users must re-register for a new account.

Website Survey - Noridian encourages suppliers to complete the ForeSee Survey on the Noridian website by clicking yes, "I'll give feedback. Noridian values your input and feedback to continue to enhance the website.

Email Updates - Suppliers are encouraged to register for the Noridian listserv to receive Medicare related information within emails on Tuesdays and Fridays. Users can customize the listserv to their business needs. The listserv is a great way for suppliers to stay on top of any changes or updates as they roll out. View the Email List Sign Up webpage to access the Email List Tutorial, Brochure and Registration link. 

Q&A Session

Q1. I have a question regarding reconsiderations in the possibility of setting up virtual notes on a beneficiary's account. We've been told that when a C2C decision is favorable, suppliers are unable to have a virtual note placed on the beneficiary's account for future dates of service to have all claims processed per that favorable reconsideration. Is there is any way to have reconsiderations applied on future dates of service?
A1. Claims allowed at the reconsideration level are specific to the date of service appealed. The determination is only applicable to that date of service. For subsequent dates of service, a supplier may need to initiate the appeal process with Redeterminations using the documentation that allowed for the successful decision of a prior date at the Reconsideration level.

Q2. Regarding replacement of DME equipment. I know the Local Coverage Determination (LCD) states that the reasonable useful lifetime (RUL) is five (5) years.  My question is around this kind of sub-policy underneath that whether the accumulated costs of repairs exceeds 60% of cost to replace the item.  In doing some more research, I'm finding some information that states that, if the contractor determines that this accumulated cost is stating that the equipment won't last the full 5 years, it will be up to the supplier to replace the equipment. What types of situations are leading to the contractor to make that determination? This is related to the external infusion pump medical LCD.
A2. In addition, DME repair may not exceed the cost of replacement. The 60% rule that is referenced in the question applies to orthotic and prosthetic items. It is supplier responsibility to provide equipment that will last the 5 year RUL, unless the equipment is lost, stolen or irreparably damaged. Thus, a supplier may have to provide replacement at no charge within that 5 year RUL, depending on the circumstances and the ability to repair the equipment.

Q3. For Group 3 wheelchairs, we get mixed information as to whether the accessories are billed as a capped rental or if they can be billed as a purchase?
A3. Group 3 wheelchairs qualify for the lump-sum purchase option. If a beneficiary chooses the purchase option, accessories can be billed as a purchase as well.

Q4. Physician ordering a concentrator and portable oxygen system. As the supplier, we obtain all documentation. A week later, a prescription is provided by the ordering physician asking to test the beneficiary for a portable oxygen concentrator (POC) and beneficiary qualifies. Are we required to get a revised CMN for that once we get the prescription for the POC?
A4. If the beneficiary qualified for the original portable with rest or exercise testing, a new test is not required for a portable oxygen concentrator. There is a requirement for a new order for the change in modality; however, a revised CMN is not required.

Q5. What are the supplier's options when a beneficiary washes their brace against instruction and the Velcro wore out? The manufacturer's one-year warranty is completed. New Velcro was provided to the beneficiary. Can the Velcro replacement be billed as a repair?
A5. Yes. The Velcro may be billed as a repair.

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Last Updated Jun 16, 2017