Browse by Topic - JA DME
Browse by Topic
Advance Beneficiary Notice of Noncoverage (ABN) - View ABN requirements, verbiage examples, coverage information and resources
Competitive Bidding - Program mandated by Congress and requires that Medicare replace the current fee schedule payment methodology for selected DMEPOS items with a competitive bid process. View details
DMEPOS Benefit Categories - View general definitions and coverage issues relating to the ten categories
DMEPOS Payment Categories - View DMEPOS categories reimbursed based on DME fee schedules
Documentation - View supplier documentation, orders - WOPD, proof of delivery and medical record information
Emergencies and Disasters - In the event of a national or regional catastrophe or disaster, view resources
Enrollment - Access the National Provider Enrollment (NPE) website to read articles, access learning & educational information, view resources and learn about Supplier enrollment related processes, rules, and regulations
Extrapolation - Commonly referred to as a statistical sampling for overpayment estimation / extrapolation. A contractor will use a supplier/provider claim history as part of the post payment review. View details
Fraud & Abuse - View information regarding fraud, abuse, and the related process to report potential concerns
Modifiers - Modifiers can be two digit numbers, two character modifiers, or alpha-numeric indicators. View details
Noncovered Items - In order for an item to be covered it must fall within one of ten benefit categories. View categories and find a HCPCS
Noridian Medicare Portal (NMP) - Access General, Registration, End User, and Administrator function related guides and details
Remittance Advice (RA) - View RA resources and access the X12 issued reason and remark codes
Repairs, Maintenance and Replacement - Payment may be made for repair, maintenance, and replacement of medically required DME. View details
Same or Similar Chart - Same or similar denials occur when the beneficiary’s Medicare order history indicates an item is the same or similar to the item being billed. Search for a DMEPOS Item or HCPCS
Upgrades - Items that go beyond what is medically necessary under Medicare's coverage requirements. An item can be considered an upgrade even if the physician has signed an order for it. View details
