Home Health Agencies (HHAs) Providing Durable Medical Equipment (DME) in Competitive Bidding Areas

Good Afternoon MFS Bloggers, If your agency is located or doing business in a competitive bidding area (CBA), please pay special attention to the CMS information posted below. This information will have profound effects on your DME revenue, if in fact you submit claims for DMEPOS for your hha beneficiaires. For those of you not currently located in a competitive bidding area, please take note as these restrictions will certainly effect your Agency once the competitive bidding program is expanded to your zip code.

Provider Types Affected
This article is for all HHAs submitting claims to Regional Home Health Intermediaries (RHHIs) for DME provided to Medicare beneficiaries residing in competitive bidding areas.

Provider Action Needed
The Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 7014 to alert HHAs that edits will be in place, effective for services on or after January 1, 2011, to prevent HHAs from billing competitively bid DME items in competitive bidding areas and consequently preventing the in appropriate payment of competitively bid DME items to HHAs. Make certain your billing staffs are aware of these changes.

Beginning January 1, 2011, in competitive bidding area, a supplier must be awarded a contract by Medicare in order to bill Medicare for competitively bid DME. Therefore, HHAs that furnish DME and are located in an area where DME items are subject to a competitive bidding program must either be awarded a contract to furnish these items in this area or use a contract supplier in the community to furnish these items. The competitive bidding items will be identified by HCPCS codes and the competitive bidding areas will be identified based on zip codes where beneficiaries receiving these items maintain their permanent residence. The DME MACs will have edits in place indicating which entities are eligible to bill for competitive bid for items and the appropriate competitive bid payment amount.

Key Points of CR 7014
Your Medicare contractor will return HH claims (types of bill 32x, 33x and 34x) to you when such claims contain Healthcare Common Procedure Coding System (HCPCS) codes that are identified as being for items or services subject to competitive bidding in a competitive bidding areas.
• For your HHA to bill competitively bid items, your HHA must also be a contract supplier under Medicare’s DME competitive bidding program.
• Note: All suppliers for competitively bid DME must bill the DME Medicare Administrative Contractors (MAC) for these items and will no longer be allowed to bill for competitive bid items to Medicare contractors processing home health claims. Home health claims submitted for HCPCS codes are subject to a competitive bidding program will be returned to the provider to remove the affected DME line items.
• The applicable HCPCS codes and Zip Codes for the competitive bidding areas can be found on the “Supplier” page of the following Competitive Bid Implementation Contractor (CBIC) Web site at http://www.dmecompetitivebid.com/Palmetto/Cbic.nsf/DocsCat/Home on the internet.
• Claims for DME furnished by HHAs that are not subject to competitive bidding may still be submitted to the appropriate home health claims processing contractor.

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