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Jurisdiction B DME MAC Supplier Manual by Chapters
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Foreword
Revised
Foreword
Revised
Chapter 1: General Information
Revised
The Medicare Program
The Medicare Card
The Common Working File
Deductible and Coinsurance
The CMS Internet-Only Manuals
Top of Index
Chapter 1 - General Information
Chapter 2: Enrollment Process
Revised
National Provider Identifier
Obtaining and Retaining Medicare DMEPOS Billing Privileges
Change Information
Directory of Medicare Suppliers
Supplier Standards
Change of Ownership
Resources Available to Assist Suppliers with the Enrollment Process
Top of Index
Chapter 2 - Enrollment Process
Chapter 3: Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program
Revised
Overview
Competitive Bidding Implementation Contractor
Contracts
Competitive Bidding Areas
Product Categories
New Competitive Bidding Modifiers
Grandfathering
Traveling Beneficiaries
Payment Rules
Competitive Bidding Program Exceptions
Top of Index
Chapter 3 - Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program
Chapter 4: Participation Program
Revised
Enrollment
Benefits of Participation
Assignment of Claims
Top of Index
Chapter 4 - Participation Program
Chapter 5: Coordination of Benefits Contractor
Revised
Coordination of Benefits Contractor
Medicare’s Role
Medicare Secondary Payer Programs
CMS MSP Questionnaire
Billing Requirements
Claim Liability Calculation
Medicare Secondary Payer Overpayments
Top of Index
Chapter 5 - Coordination of Benefits and Medicare Secondary Payer
Chapter 6: Medical Policy Information
Revised
General Medical Policy Information
Current DMEPOS Medical Policies
Top of Index
Chapter 6 - Medical Policy Information
Chapter 7: Certificates of Medical Necessity/DME MAC Information Forms
Revised
Overview
DME MAC Forms
External Infusion Pumps & Enteral/Parenteral Nutrition
CMNS/DIFS Completion Instructions
Cover Letters
Sample CMN Forms
HCPCS Codes Requiring a CMN or a DIF
Top of Index
Chapter 7 - Certificates of Medical Necessity/DME MAC Information Forms
Chapter 8: Documentation
Revised
Orders
Certificates of Medical Necessity
Documentation in the Patient's Medical Record
Proof of Delivery Requirements
Requests for Additional Information
Top of Index
Chapter 8 - Documentation
Chapter 9: Advance Determination of Medicare Coverage
Revised
Eligible Items
Submitting ADMC Requests
ADMC Requirements
ADMC Determination
Top of Index
Chapter 9 - Advance Determination of Medicare Coverage
Chapter 10: Advance Beneficiary Notice
Revised
General Guidelines
Limitation on Liability
Upgrades
Advance Beneficiary Notice of Noncoverage Completion
Top of Index
Chapter 10 - Advance Beneficiary Notice
Chapter 11: Claim Filing Jurisdiction
Revised
Claim Filing Based on Beneficiary Address
Disposition of Incorrectly Filed Claims
Durable Medical Equipment Medicare Administrative Contractors
DME MAC Jurisdictions
Top of Index
Chapter 11 - Claim Filing Jurisdiction
Chapter 12: Claim Submission
Revised
Acceptable Claim Formats
Claim Filing Time Limits
Signature on File Requirements
Ordering Claim Forms
Ordering Information
CMS-1500 Hints and Tips
New Revised CMS-1500 Claim Form (Version 08-05)
Sample CMS-1500 Claim Form (Version 08-05)
CMS-1500 Claim Form (Version 08-05) Field Descriptions and Instructions
Mailing Address
Resources
Top of Index
Chapter 12 - Claim Submission
Chapter 13: Electronic Data Interchange
Revised
Electronic Media Claims
Administrative Simplification Compliance Act
Common Electronic Data Interchange
Electronic Format
How to Become an Electronic Submitter
Front-End Edit Report
Electronic Remittance Advice
Electronic Funds Transfer
Claim Status Inquiry/Beneficiary Eligibility
Jurisdiction B DME MAC EDI Help Desk
E-Commerce Consultants
National Government Services Web Site
Listserv
E-Commerce Connection
Top of Index
Chapter 13 - Electronic Data Interchange
Chapter 14: Level II HCPCS Codes and HCPCS Modifiers
Revised
Level II HCPCS Codes
HCPCS Modifiers
The Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC)
Top of Index
Chapter 14 - Level II HCPCS Codes and HCPCS Modifiers
Chapter 15: DMEPOS Payment Categories
Revised
Inexpensive or Other Routinely Purchased DME
Items Requiring Frequent and Substantial Servicing
Customized Items
Other Prosthetic and Orthotic Devices
Transcutaneous Electrical Nerve Stimulators
Parenteral and Enteral Nutrition Pumps
Home Dialysis Supplies
Sample ESRD-382 Form
Capped Rental Items
Sample Rent/Purchase Option for Electric Wheelchairs Letter
Oxygen and Oxygen Equipment
Repairs, Maintenance and Replacement
Top of Index
Chapter 15 - DMEPOS Payment Categories
Chapter 16: Pricing
Revised
Fee Schedules
Reasonable Charges
Drug Pricing
Individual Consideration
Inherent Reasonableness
Top of Index
Chapter 16 - Pricing
Chapter 17: Medicare Benefit and Denial Categories
Revised
Benefit Categories
Denial Categories
Prevention of Common Claim Submission Errors
Top of Index
Chapter 17 - Medicare Benefit and Denial Categories
Chapter 18: Supplier Remittance Notice
Revised
General Information
Tips for Reading the Remittance Notice
Sample Remittance Notice
Remittance Notice Key
Resources
Top of Index
Chapter 18 - Supplier Remittance Notice
Chapter 19: Medicare Summary Notice
Revised
Sample MSN
Summary of Numbered Fields on Sample MSN
Resources
Top of Index
Chapter 19 - Medicare Summary Notice
Chapter 20: Reopenings and Appeals
Revised
Reopenings for Minor Errors and Omissions
Appeals
Sample Jurisdiction B DME MAC Request for Redetermination Form
Sample Jurisdiction B DME MAC Reconsideration Request Form
Sample Form CMS - 1696 Appointment of Representative
Top of Index
Chapter 20 - Reopenings and Appeals
Chapter 21: Overpayments
Revised
DME MAC Initiated Demand Letters
The Offset Process
Immediate Offset by Fax
Sample Jurisdiction B DME MAC ORU Offset Request Form
Supplier Voluntary Refunds
Sample Jurisdiction B DME MAC ORU Voluntary Refund Form
Change of Address
Top of Index
Chapter 21 - Overpayments
Chapter 22: Customer Care
Revised
Interactive Voice Response Unit
Customer Care Contact Center
Telephone Inquiries
Written Inquiries
Top of Index
Chapter 22 - Customer Care
Chapter 23: Resources
Revised