DME MAC Program Manager Update - Post-Public Health Emergency Education - JA DME

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 highlighting the DME MACs’ collaboration on ensuring Post-Public Health Emergency (PHE) procedures and education is consistent across jurisdictions.

The federal PHE for COVID-19, declared under Section 319 of the Public Health Service (PHS) Act, expired on May 11, 2023. The DME MACs worked with CMS and each other to ensure that suppliers and ordering clinicians had the necessary information to bill Medicare and retain the required supporting documentation.

The DME MACs began early planning through the respective operational workgroups and with CMS for the post-PHE environment. The following are just a few examples of workgroup activities:

During April, the DME MACs met with various CMS areas to discuss and prepare for the end of the PHE. One item of particular importance was providing instructions regarding modifier use on claims billed post-PHE for items obtained by a beneficiary during the PHE where CMS suspended qualifications. Through discussions with CMS, DME Medical Directors (DMDS), and other DME MAC teams, the group concluded that the Change Request (CR) modifier would continue to be active. The DMDs created and posted an article to all DME MAC websites with directions for post-PHE billing on April 28.

The DME MAC Systems Support teams ensured that updates to system editing were consistent across jurisdictions.

The DME MAC Claims processing teams worked together to ensure a consistent understanding of CMS technical direction and to implement consistent claim processing guidelines for the post-PHE environment.

The Medical Review (MR) teams worked closely with CMS to prepare for the post-PHE impact on MR, in addition to working with the DME MAC Provider Outreach and Education (POE) teams on the unique educational needs for MR.

Each of the DME MAC supplier contact centers partnered with their POE teams to educate staff on the upcoming changes and the resources available for both our internal staff and external customers.

Throughout the planning process for the post-PHE environment, our POE teams supported all operational areas with their education needs, partnered with CMS on consistent messaging, and provided timely, comprehensive and consistent education to the national supplier community.

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