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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 WPC 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

Last Updated May 10 , 2024