DIABETIC SHOES - SURETY BONDS

BREAKING NEWS  recent clarification from CMS regarding diabetic shoes in relation to the surety bond. According to CMS staff, if you provide a Medicare patient with diabetic shoes that are not related to an orthotic or prosthetic device, the shoes are no longer considered "supplies". 

This means that if you provide stand alone diabetic shoes, 1) they would no longer fall under the surety bond exemption for supplies and 2) your facility would now be providing services other than orthotics, prosthetics or supplies. This means that you would no longer qualify for the surety bond exemption and must therefore meet the October 2, 2009 deadline for obtaining a bond.

However, if the only time that you provide diabetic shoes is in conjunction with an orthotic or prosthetic device, the shoes would still be considered "supplies" and you could maintain your surety bond exemption, as long as you meet the other necessary.

 

Click here to Read the FAQ and Question 38 on the NSC Web site.

Consignment Closet

BREAKING NEWS!

As published by AOPA

CMS has just announced that effective September 8, 2009, there will be new supplier standards for anyone participating in a consignment closet arrangement.  As of that date, in order for a facility to be able to place devices in a physician or non-physician practitioner's office, it must comply with the following rules:
1.    Title to the device must be transferred to the physician/non-physician practitioner at the time that the device is furnished to the patient.
2.    The physician/non-physician practitioner must be the entity to bill Medicare, using his/her own supplier number.
3.    All services provided to the patient concerning fitting or use of the device must be performed by person being paid by the physician/non-physician practitioner and not by the O&P facility.
4.    The patient must be told that if he/she has a problem or question regarding the device, they should contact the physician/non-physician practitioner and not the O&P facility who placed the device in the physician/non-physician practitioner's office.
Additionally, the National Supplier Clearinghouse will be verifying that two or more DMEPOS suppliers are not enrolled/located at the same practice location. 

 

 

Click here to read the CMS notice on these new requirements

Surety Bond

FOR IMMEDIATE RELEASE

For more information contact Kathy Struecker at (515) 295-2461, ext. 4260 or Kathy.struecker@phmic.com.

 

MEDICARE SURETY BOND UPDATE

The May 4, 2009 deadline for the Medicare Surety Bond has now come and gone.  All suppliers of Durable Medical Equipment and Prosthetics, Orthotics and Supplies (DMEPOS) that are applying for new National Provider Identifier (NPI) numbers should now have their Medicare Surety Bonds for their pending applications.  All future applications will need to include a bond for the application to be accepted by Medicare.

DMEPOS suppliers should now be securing bonds for the October 2, 2009 deadline.  While that date is months away, the demand in the two months prior to the deadline will be very large and possibly make it difficult to have the bond issued and sent to Medicare within the proper timeframe.  We are encouraging suppliers not to wait.

Pharmacists Mutual Insurance Company’s subsidiary, Pro Advantage Services, Inc., d/b/a Pharmacists Insurance Agency (in California) has made arrangements with CMS approved bonding companies (“T” listed) at rates starting at $250 per $50,000 bond.  Applications are being accepted now.

Contact us at:

Email –     MedBond@phmic.com
Phone –     1-800-247-5930 Ext. 4260
Fax –         515-295-4360

You can also contact your Pharmacists Mutual Representative for assistance.  Additional information and background

Therapeutic Shoes

Therapeutic Shoes for Diabetics - Physician Documentation Requirements for DME Reimbursement There is a lot of talk about what is required by Medicare in order for a facility to dispense shoes to a diabetic patient.  Medicare is quite clear about these required documents though there is some questions physicians have of just what they need to provide.  Medicare covers therapeutic shoes and inserts for persons with diabetes. This statutory benefit is limited to one pair of shoes and up to 3 pairs of inserts or shoe modifications per calendar year. However, in order to qualify, the Medicare statute mandates specific coverage and documentation requirements that must be met.  Attached herein is a copy of the correspondence from Dr. Robert D. Hoover, Jr MD, MPH, FACP - Senior Medical Director DME MAC Juristiction C directed to physicians explaining what documentation is required. Click Here to see this letter.

 

Report to Medicare STAT

Failure to Update Your Medicare Enrollment Record may Lead to Deactivation of Medicare Billing Privileges

All providers/suppliers are required per Federal Regulation 42 CFR §424.520 to report changes to their practice location and changes of ownership within 30 days and report all other changes within 90 days to their Medicare contractor. Failure to update information can result in deactivation or revocation of a provider's billing privileges.

Information is updated through submission of the applicable CMS Provider Enrollment application(s). If the application is missing required items or data elements or contains inaccurate information, the provider enrollment department of CIGNA Government Services will send the provider/supplier a letter. The letter will include a listing of additional items, supporting documentation, or missing data elements required to process the change.

In compliance with Federal Regulations found at 42 CFR §424.525, providers/suppliers are required to respond to the contractor by submitting all requested information within 30 calendar days from the date of the contractor's request. Failure to comply with the contractor's request can result in the deactivation of the provider's/supplier's Medicare billing privileges.

Applications that are received complete and accurate are processed timely. However, processing is delayed for incomplete or inaccurate applications. If you need additional information regarding the enrollment process, please visit our website at www.cignagovernmentservices.com and select Part B and then select Provider Enrollment or call our toll free number 1.866.520.4007. CMS applications can be downloaded here or contact Medicare at  http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp for a copy.

Mail your applications or any enrollment inquiries to:

CIGNA Government Services
Provider Enrollment
P.O. Box 25226
Nashville, TN 37202

 

 

Historic Agreement

December 18, 2008 04:01 PM

FOR IMMEDIATE RELEASE:                CONTACTS: See Below    December 18, 2008

HISTORIC AGREEMENT PROTECTS PATIENTS AND IMPROVES QUALITY OF CUSTOM ORTHOTIC AND PROSTHETIC CARE

Five of the major national organizations representing the clinical, business, and quality improvement aspects of the orthotic and prosthetic (“O&P”) profession announced an historic agreement today to promote a consensus set of minimum education and training requirements for providers and suppliers of custom orthotics and prosthetics (i.e., orthopedic braces and artificial limbs).  The announcement comes as the Centers for Medicare and Medicaid Services (“CMS”) is drafting long-overdue proposed regulations to prohibit payment to any provider or supplier that is not qualified through specific education and training to demonstrate competency to treat patients requiring custom orthoses and prostheses.  Currently, the Medicare program does not require any specific education and training for providers and many suppliers who provide O&P patient care.

“This is a great day for Medicare patients with amputations or other physical disabilities requiring O&P care,” stated Tom Guth, C.P., President of the National Association for the Advancement of Orthotics and Prosthetics (“NAAOP”).  “This agreement marks the first time the major O&P organizations have come together to state a consensus position on minimum standards that any provider or supplier must have to demonstrate competency.”

“This consensus position stems from legislation enacted in 2000, the Benefits Improvement and Protection Act (“BIPA”), that sought to protect Medicare patients from unqualified practitioners and suppliers while limiting the potential for fraud and abuse,” said James P. Rogers, C.P.O., FAAOP, President of the American Academy of Orthotists and Prosthetists (“AAOP”).  “We are hopeful that CMS will seriously consider this consensus position from the O&P profession as they determine which providers and suppliers have specific education and training sufficient to warrant payment by Medicare for custom orthotics and prosthetics.”

The agreement establishes specific education requirements by mandating a bachelor’s degree, as well as specific formalized instruction, from accredited O&P schools as the only standard in the United States for providers and suppliers of custom O&P patient care.  Reference to accredited schools means a comprehensive set of O&P specific courses will be required before a candidate is qualified to sit for an exam in orthotics or prosthetics administered by one of two O&P credentialing organizations.  A training requirement stipulates that candidates must engage in supervised patient care for at least one year in each discipline (e.g., orthotics or prosthetics).  Finally, a grandfathering provision will phase in the consensus requirements.

“With O&P technology becoming more complex and the wide array of knowledge and skills needed to provide quality care, these consensus education and training requirements establish a benchmark for quality into the future,” stated Robert S. Lin, C.P.O., FAAOP, President of the American Board for Certification in Orthotics, Prosthetics and Pedorthics (“ABC”). 

Added Preston N. Madler, BOCO, Chairman of the Board of Directors of the Board for Certification/Accreditation, International (“BOC”), “And the grandfathering provision will ensure that eligible candidates who wish to take our O&P competency exams are not penalized as these requirements come into effect.”

The five organizations believe that this agreement will help CMS implement appropriate education and training standards for O&P patient care through the regulations they plan to propose in the near future.  “We see these education and training requirements as the long-term standard that should be adopted by all public programs and private payers of custom orthotic and prosthetic care, including state licensure initiatives,” stated Brian L. Gustin, President of the American Orthotic & Prosthetic Association (“AOPA”).  “We expect that CMS will adhere to the congressional intent of the statute they are regulating and do the right thing for Medicare patients requiring O&P care.”

The five organizations that are parties to this agreement are the following:

American Academy of Orthotists and Prosthetists – (“AAOP”).  The Academy is the national organization representing the professionals who provide patient care in the field of Orthotics and Prosthetics. Contact: Peter D. Rosenstein, Executive Director, tel. (202) 380-3663.

American Board for Certification in Orthotics and Prosthetics – (“ABC”).  ABC is a national certifying and accrediting body for the orthotic, prosthetic and pedorthic professions. Contact: Catherine A. Carter, Executive Director, tel. (703) 836-7114.

American Orthotic and Prosthetic Association – (“AOPA”).  AOPA is the largest non-profit organization dedicated to helping orthotic and prosthetic businesses and professionals navigate the multitude of issues surrounding the delivery of quality patient care. Contact: Thomas F. Fise, Executive Director, tel. (571) 431-0802.

Board for Certification/Accreditation, International. – (“BOC”).  The BOC certifies orthotists, prosthetists and pedorthists, and accredits facilities of durable medical equipment, prosthetic and orthotic suppliers. Contact: Greg Safko, President, tel. (410) 581-6222.

National Association for the Advancement of Orthotics and Prosthetics – (“NAAOP”).  NAAOP is a non-profit trade association dedicated to educating the public and promoting public policy that is in the interest of the O&P patient. Contact: George W. Breece, Executive Director, tel. (800) 622-6740.

American Academy of Orthotists and Prosthetists (AAOP)

American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC)

American Orthotic & Prosthetic Association (AOPA)

Board for Certification/Accreditation, International (BOC)

National Association for the Advancement of Orthotics and Prosthetics (NAAOP)

December 18, 2008

VIA FACSIMILE AND REGULAR MAIL

The Honorable Michael O. Leavitt
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue S.W.
Washington, D.C.  20201

    Re:    Regulation of BIPA § 427 Regarding Qualifications for Orthotic and                 Prosthetic Providers and Suppliers

Dear Secretary Leavitt:

    Attached please find a press release and joint statement of agreement between five of the national organizations representing the clinical, business, and quality improvement aspects of the orthotics and prosthetics profession.  This historic agreement delineates for the first time a consensus position in the profession regarding the minimum education and training requirements that providers and suppliers must satisfy in order to provide custom orthotic and prosthetic care. 

As the Centers for Medicare and Medicaid Services (CMS) moves forward with issuance of proposed regulations pursuant to § 427 of the Benefits Improvement and Protection Act of 2000 (BIPA), we ask for your serious consideration of this important agreement.

    Further, we would like to meet with those at CMS who are on the front lines of drafting the proposed regulations in order to discuss education and training matters in more depth.  We will follow up with them directly.

    If you need to contact us, please call Peter W. Thomas, Esq. at (202) 466-6550. Thank you.

Sincerely,
  
James P. Rogers, CPO, FAAOP
President, American Academy of Orthotists and Prosthetists
   
Robert S. Lin, CPO, FAAOP
President, American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc
   
Brian L. Gustin, CP
President, American Orthotic & Prosthetic Association
   
Preston N. Madler, BOCO
Chairman, Board of Certification/Accreditation, International
   
Thomas Guth, CP
President, National Association for the Advancement of Orthotics and Prosthetics

Encls.

cc:    Kerry Weems, Acting Administrator, CMS
    Tim Hill, CFO, CMS
Laurence Wilson, CMS
Kimberly Brandt, CMS
Sandra Bastinelli, CMS

Exempt from Accreditation?

CMS Telephonic Conferance Call Wednesday September 3rd brought changes to the mandated Accreditation Process. It was announced Wednesday that physicians, PTs, OTs, qualified speech therapists, physician assistants, nurse practitioners, nurse midwives, orthotists, prosthetists, pedorthists, podiatrists, optometrists and opticians are exempt from the September 30, 2009 and many others are now exempt. They also stated that this is only a delay in the process as they are revising the Accreditation requirements and Quality Standards for these professionals and will issue the new Standards sometime in 2009.  This seems to be a wide open door to these professionals but there are rules which preclude them from having unlimited exemption.

MOST IMPORTANT - DEADLINE FOR ACCREDITATION APPLICATIONS JANUARY 2009

CMS also announced during this phone conference that there is now a deadline of January 2009 to have your Application in to the Accrediting Organization in order to ensure your ability to complete the process by September 2009. Don't wait as bottle-necking is for sure to happen.

Exemptions were given to individual professionals not product categories:

If a physician is the owner in name only of a DME retail operation they are NOT exempted.

If a physician is dispensing and billing O & P products from his office but he is NOT the one fitting the device, they are NOT exempted. (Physician must be the one dispensing the product)

If a DME supplier is supplying O & P and employ and Orthotist and/or Prosthetist they are NOT exempted

If an O & P facility bills for other items other than O & P they are NOT exempted

Mastectomy Fitters and Orthotic Fitters are NOT exempted

Beginning next week you can read the transcripts from yesterdays conference call at the CMS web site

www.cms.hhs.gov/medicareprovidersupenroll

The Quality Standards with the approved proposed standards should be listed on the CMS web site by next week.

MORE TO COME SOON.....................

Medicare Quality Standards

NEW CMS QUALITY STANDARDS

CMS Announced, in October, the new revised Quality Standards that all DMEPOS suppliers MUST abide by. Pay particular attention to the high-lighted areas.

Click on the link below to access these Standards.

Click here to see Quality Standards

Oxygen Changes

Proposed Rule OXYGEN

The rules are found in the regulation titled “Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B (CMS-1403-FC),” and is now available for review and comment.

Revised CMS Quality Standards

CMS Final Revised DMEPOS Quality Standards Posted

CMS has issued its revised quality standards. During a 4 1/2-hour phone conference last week CMS posted the new final revised Standards directed to DMEPOS providers that had not yet obtained accreditation. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) required all DMEPOS suppliers to meet quality standards for Medicare accreditation by September 30, 2009.

It was also stated by Medicare that those facilities who do not apply with one of the ten Accreditation Organizations by January 2009, there would be no way to guarantee success in becoming accredited by the September deadline.

All suppliers that furnish the following items or services must comply with the quality standards in order to receive Medicare Part B payments and to retain a supplier billing number.

The covered items include:

• DME
• Medical supplies
• Home dialysis supplies and equipment
• Therapeutic shoes
• Parenteral and enteral nutrient, equipment and supplies
• Prosthetic devices, prosthetics, and orthotics
• Transfusion medicine

Sandra Bastinelli from CMS offered advice and answered several questions on meeting the standards During the Tuesday conference. Bastinelli commented that the October 2008 final standards contain minimal changes from the February 2008 draft proposal.

OIG Opinion re Consignment Closets

OIG looks at both proposed arrangements and concluded that they would not violate the anti-kickback statute

• Patients will be given a choice of suppliers, including outside suppliers outside of the hospital.
• The consignment closets will be provided at no cost to the suppliers, as will phone systems and desks by the DMEPOS personnel, there will be no referrals flowing from the suppliers to the hospital (the remuneration and referrals flow the same way).
• The DMEPOS personnel will have no contact with patients until the patients choose the supplier as their DMEPOS supplier.

To see advisory opinion 8-20 (posted Nov 26-2008) see more click here.

Clarification on PMD orders

Questions answered by Medical Director Juristiction A

Subject: RE: Clarification on 7 element orders - 3 or 2 or 1 Help!!!

The first issue is: what is the face-to-face exam? Many suppliers and physician's seem to define it as only the in-person visit. The policy talks about it as having 2 elements (refer to the documentation section),

1. An in-person visit with the physician, and

2. A medical examination.

Both need to be done and documented. This concept gets confusing because folks separate the exam done by the physician and the PT/OT, (if one is done), and consider them as separate. For this LCD there are really 3 scenarios. All require an in-person visit to the doctor and only are different by how much of the medical exam is done and documented by the physician. They are:

1. The physician does it all and creates the report.

2. The physician does some parts of the exam and refers other to someone else (often a PT/OT) to do the rest. The physician prepares a report on their part and signs off on the referral exam.

3. The physician refers the exam. The referral does the exam and creates the report. The physician signs off on it.

The in-person visit AND the exam together comprise the face-to-face.

The face-to-face must be complete BEFORE the 7-element order is written. This requirement comes from the statute and we have published it in the Policy Article "Nonmedical Necessity Coverage and Payment Rules" section (which is where we put statutory requirements). It says,

"FACE-TO-FACE EXAMINATION:
For a power operated vehicle (POV) or power wheelchair (PWC) to be covered, the treating physician must conduct a face-to-face examination of the patient before writing the order and the supplier must receive a written report of this examination within 45 days after completion of the face-to-face examination and prior to delivery of the device. If this requirement is not met, the claim will be denied as non-covered. "

As I said before, I understand that many physicians want to write their prescriptions after their in-person visit. That is acceptable ONLY when they actually do the examination and create the report from their information. If they choose to refer the patient elsewhere fore an evaluation, they must wait until they receive that report. After receiving the report, they must indicate their acceptance of the findings and sign/date it. The date that is done becomes the date of the face-to-face exam and when complete THEN the 7-element order can be written.

Paul J. Hughes, MD
Medical Director
Jurisdiction A DME MAC
NHIC
75 Sgt. William B. Terry Drive
Hingham, MA 02043
803-359-2759