Updates from CGS Medicare on DMEPOS Topics for NC, SC, VA and WV

Published 10/30/2020

CGS Medicare continues to provide education to Durable Medical Equipment (DME) suppliers even during the COVID-19 public health emergency (PHE). CGS understands the difficulties suppliers are facing during this time. Suppliers have access to webinars, teleconferences and other virtual events designed to increase knowledge and understanding. Although changes have been put into place to limit the beneficiary’s exposure to COVID-19, practitioners must continue to daocument the condition that necessitates the need for any item billed to Medicare. We encourage suppliers and practitioners to work together, as CGS continues to collaborate with Palmetto GBA to provide education to these groups on changes that affect billing, coverage and coding. 

The top errors remain the same even during the PHE. These errors involve orders, medical records, same or similar, and documentation to support the number of items billed. If the DMEPOS supplier contacts the treating practitioner for additional information, the supplier must have documentation to support the item that was prescribed for the beneficiary. 

What’s New

CGS awarded the Jurisdiction C Contract

The Centers for Medicare and Medicaid Services (CMS) announced on August 20, 2020, CGS Administrators, LLC (CGS) as the Jurisdiction C Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC). The contract is for a period of seven years, from September 1, 2020, through August 31, 2027. The award announcement was a re-competition of the Jurisdiction C DME MAC contract under the competitive contracting provisions of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. CGS has a dedicated webpage detailing for this important announcement. 

DME MACs Resume Medical Review on a Postpayment Basis

To protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming fee-for-service medical review activities. Beginning August 17, the MACs are resuming with post-payment reviews of items/services provided before March 1, 2020. The Targeted Probe and Educate program (intensive education to assess provider compliance through up to three rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate.

Documentation Checklists have been updated to provide suppliers with guidance on compliant documentation based on specific policy groups. These checklists are designed to assists suppliers in determining if they have all the documentation needed to support the medical necessity for the item being provided to the Medicare beneficiary. 

Physician's Corner is specifically designed for the benefit of physicians and practitioners who prescribe DMEPOS items for Medicare beneficiaries. Included in this section is important physician-based information pertinent to both the physician and the supplier that provides the items and services to your patient.

The Claim Denial Resolution Tool was developed to provide the supplier community guidance on how to address claim denials in the most efficient manner. This tool provides the remittance message for the denial and the possible causes and along suggested resolutions. Suppliers have access to the most common denials using this tool. The Claim Denial Resolution Tool was recently updated to include additional denial types.

In addition to the recently updated items on the CGS website, suppliers are reminded to use the following items to assist with billing: 

  • CGS a dedicated web page for information on COVID-19
  • Self-Service Guide – This PDF version of the guide is a convenient source for information about all the self-service tools and calculators available to suppliers for easy reference
  • Visit the myCGS Web Portal for details on the many features available in our secure online web portal

If you have ideas or suggestions on how CGS can improve on the types of education we provide on DMEPOS items and the documentation needed, please contact us using the following:

Please respond quickly and completely to requests for documentation from the DMEPOS supplier.  This helps the supplier to continue to provide services ordered for your Medicare beneficiary.  

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