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Health Care Information Services from DecisionHealth
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July 2009 Update
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ABN_Notice
ACCREDITATION
ADVERTISING
AIR-FLUIDIZED BEDS
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Five levels of appeal
DME MAC reviews – the first level of appeal
Collapse Reconsideration - The Second Level of AppealReconsideration - The Second Level of Appeal
Who decides your QIC appeal
Where to file QIC appeals
Make sure you have all data at QIC level
DME MAC responsibilities at the reconsideration level
Reopening of claims
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How to request an ALJ hearing
Where to file a request for an ALJ hearing
Who attends ALJ hearings and what to bring
What happens after ALJ hearing ends
Appeals Council Review
Judicial Review
10 tips -- straight from the judge’s mouth
How to prepare and present your best ALJ case
DME MAC Q&A
ARTIFICIAL ARMS, HANDS, LEGS & FEET
ASSIGNED/UNASSIGNED CLAIMS
AUDITS
AUTOMATIC EXTERNAL DEFIBRILLATORS-ABCD
BEST BILLING PRACTICES
BILLING SERVICES
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Region ABCD DMERC medical policy: Ankle-foot/Knee-ankle-foot orthosis
Region ABCD DMERC medical policy: Spinal orthoses: TLSO & LSO
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Region A,B,C,D DMERC medical policy: External breast prostheses
Canes&crutches-ABCD
CAPPED RENTAL
CASH ADVANCES
CERTIFICATES OF MEDICAL NECESSITY (CMNs) & PHYSICIANS’ ORDERS
CERTIFICATE OF MEDICAL NECESSITY FORMS
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CERVICAL TRACTION DEVICES-ABCD
CHARGES FOR MEDICARE SERVICES
CLAIMS FILING
CLAIMS INQUIRIES TO THE DME MAC
CLAIMS PROCESSING -- CERT FINDINGS
CMS-1500
CODING: DIAGNOSIS
CODING: HCPCS
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Region ABCD DMERC medical policy: Cold Therapy
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Commodes_ABCD
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Single Payment Amount
Cities Selected for the Second Round
Affected Product Categories
Three Ways to Sell in Competitive bidding without winning
Networks May Bid
Grandfathered Sales Permitted
Competitive bidding implementation contractor responsibilities
Competitive bidding advisory committee
Lessons Learned From Competitive Bidding
Instructions for completing Request for Bids
COMPLIANCE PLANS
CONSIGNMENT CLOSETS
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Regions ABCD medical policy: Continuous Positive Airway Pressure system
COPAYMENT/DEDUCTIBLE WAIVERS
COVERED/NON-COVERED SERVICES
CROSS REFERENCE
CUSTOMER SERVICE/INTAKE
DATE OF SERVICE
DEADLINES FOR FILING CLAIMS
DEADLINES FOR PAYING CLAIMS
DEATH/DISABILITY OF A PATIENT
DELIVERY & SERVICE
DENIALS OF CLAIMS
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Region ABCD DMERC medical policy: Home dialysis supplies & equipment
DISCLOSURE OF MEDICARE INFORMATION
DME MACs
DROPPING OUT OF MEDICARE
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Region ABCD DMERC medical policy: Oral Anticancer drugs
Region ABCD DMERC medical policy: Oral Antiemetic drugs (Replacement for Intravenous Anteimetics)
DURABLE MEDICAL EQUIPMENT: AN OVERVIEW
ELECTRONIC DATA INTERCHANGE
ELECTRONIC MEDIA CLAIMS
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Epoetin ABCD
EXPLANATION OF MEDICARE BENEFITS TO PATIENTS
EXPLANATION OF MEDICARE BENEFITS TO SUPPLIERS
EYE CARE: AN OVERVIEW
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Eye prostheses-ABCD
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FACIAL PROSTHESES ABCD
FEE SCHEDULES - 2008
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Fraud & Abuse Definitions
Fraud & Abuse Penalties
Fraud & Abuse Investigations
Expert Advisor: If you are investigated
GRANDFATHERING
HEALTH INSURANCE CLAIM NUMBER (HICN)
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
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HIGH FREQUENCY OSCILLATION-ABCD
HOME: A DEFINITION
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Region ABCD DMERC medical policy: Home Blood Glucose Monitors
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Region ABCD DMERC medical policy: Hospital Beds and Accessories
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Region ABCD DMERC medical policy: Immunosuppressive drugs
INDIRECT PAYMENTS
INFRARED HEATING PADS-ABCD
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Region ABCD DMERC medical policy: Infusion Pumps
INHERENT REASONABLENESS
INSURANCE VERIFICATION
INTAKE FORMS
INTERMITTENT POSITIVE PRESSURE BREATHING MACHINES (IPPB)
Collapse INTRAOCULAR LENS & EYEGLASS COVERAGEINTRAOCULAR LENS & EYEGLASS COVERAGE
Intraocular/Refractive lenses & Eyeglass-ABCD
INTRAOCULAR LENS & EYEGLASS REIMBURSEMENT
INTRAPULMONARY VENTILATION-ABCD
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LOWER-LIMB PROSTHESES ABCD
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Lymph pumps -ABCD
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MECHANICAL IN-EXSUFFLATION DEVICES-ABCD
MEDICAID
MEDICAL NECESSITY/REASONABLENESS
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How to read a PSC medical policy
When there’s no PSC medical policy
MEDICAL REVIEW OF CLAIMS
MEDICARE OVERVIEW
MEDICARE SECONDARY PAYER BILLING RULES
MEDIGAP
METERED DOSE INHALERS
MODIFIERS
MONITORING OF CLAIMS
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Region ABCD DMERC medical policy: Nebulizers
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Region ABCD DMERC medical policy: Negative Pressure Wound Therapy Pumps
OFFICE OF THE INSPECTOR GENERAL RECOMMENDATIONS FOR HME
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Regions ABCD DMERC medical policy: Orthopedic footwear
OSTEOGENESIS STIMULATORS-ABCD
ORTHOTICS & PROSTHETICS (O&P): OVERVIEW
ORTHOTICS & PROSTHETICS: PROBLEMS WITH ORDERS
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Ostomy supplies - ABCD
OVERPAYMENTS
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A quick tour of Medicare's approach
3 keys to understanding Medicare's oxygen rules
Not covered: 4 conditions, 5 types of equipment, 1 service
Certification & recertification requirements
How to recertify home oxygen therapy
3 groups of oxygen patients
Blood gas testing
CMS portable concentrator K code
Use these oxygen modifiers
Requirements for oxygen CMNs
7 keys to lock-up 02 medical necessity
Signature needed for oxygen contents
Portable oxygen tips
Portable 02 in hospitals, clinics OK, OIG says
Physician evaluation
Maintenance, repair & replacements usually not covered
The 36-month rule, & who owns which tanks
FDA issues advisory on 02 tank connections
Airline 02 not covered
Delivery generally not paid separately
Figuring it all out: When to bill separately
DMACs target oxygen equipment for audits
Billing Best Practices
Oxygen Prescription Form.pdf
DMAC Q&A
CMS & DMAC Transmittals (redacted)
Oxygen policy reminders
Oxygen-ABCD
Collapse PARENTERAL/ENTERAL NUTRITION (PEN) FEEDING THERAPY: OVERVIEWPARENTERAL/ENTERAL NUTRITION (PEN) FEEDING THERAPY: OVERVIEW
Region ABCD DMERC medical policy: Enteral Nutrition
Region ABCD DMERC medical policy: Parenteral Nutrition
PEN FEEDING THERAPY: CERTIFICATE OF MEDICAL NECESSITY (CMN)
PEN FEEDING THERAPY: FOOD & DRUGS
PEN FEEDING THERAPY: PUMPS & POLES
PEN FEEDING THERAPY: REIMBURSEMENT
PEN FEEDING THERAPY: SUPPLIES
PARTIAL PAYMENT
PARTICIPATION/NON-PARTICIPATION IN MEDICARE
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Patient lifts-ABCD
PAYMENT CATEGORIES FOR DMEPOS
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Region ABCD DMERC medical policy: Power-operated Vehicle
PRIOR AUTHORIZATION
PROSPECTIVE PAYMENT SYSTEM
PURCHASED EQUIPMENT
REGIONAL OFFICES OF CMS
REHABILITATION/ASSISTIVE TECHNOLOGY
REPAIR, MAINTENANCE, SERVICING, REPLACEMENT
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Region ABCD DMERC medical policy: Respiratory Assist Devices
RESPIRATORY THERAPY
SADMERC
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Region ABCD DMERC medical policy: Seat-lift mechanisms
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Region ABCD DMERC medical policy: Therapeutic shoes for diabetics
SIGNATURES: ELECTRONIC CLAIMS
SIGNATURES: PAPER CLAIMS
SIGNATURES: SUPPLIERS
SKILLED NURSING FACILITIES (SNFs)
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Speech generating devices Region ABCD
SPINAL ORTHOSES-ABCD
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Region ABCD DMERC medical policy: Suction pumps
SUPPLIER NUMBERS
SUPPLIER STANDARDS
SUPPLIES
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Support surfaces 1-ABCD
Support surfaces 2-ABCD
Support surfaces 3-ABCD
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Surgical dressings-ABC
Surgical dressings-D
Collapse TENS, OSTEOGENIC & OTHER ELECTRICAL STIMULATORSTENS, OSTEOGENIC & OTHER ELECTRICAL STIMULATORS
Regions ABCD DMERC medical policy: Osteogenesis stimulator
Region ABCD DMERC medical policy: Transcutaneous electrical nerve stimulators & related supplies
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Tracheostomy-ABCD
TRAPEZE BARS & OTHER BED ACCESSORIES
UPINs, PROVIDER NUMBERS
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Region ABCD DMERC medical policy: Urological supplies
VENTILATOR/RESPIRATOR
WAIVER OF LIABILITY/ ADVANCE BENEFICIARY NOTICE (ABN)
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Region ABCD DMERC medical policy: Walkers
WARRANTIES
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Manual wheelchair coverage requirements
Manual wheelchair HCPCS chart
Criteria for manual chair coverage
Documentation for manual chairs
How to claim special wheelchairs
Rolling roll-about or geri chairs
How to claim an ultralight (K0005)chair
How to claim K0009s and pediatric chairs
How to claim individualized chairs
Billing Case Studies
DME MAC Q&A
Wheelchair-manual-ABCD
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Power mobility codes you must use