Billing, Coding and MoreAOA Seeks Exclusion to DMEPOS Rules for Providers of Post-Cataract LensesEd. Note: The Center for Medicare and Medicaid (CMS) has initiated a policy that would require optometrists, among other providers, to spend $3000 or more every three years to be 'accredited' by next June so that they can be reimbursed for post-cataract eyeglasses from DMERC. TOA and AOA are working with CMS and Congress to overturn the policy for small businesses. Either way, if you choose NOT to participate, you can still bill Medicare for exams and tests, but not for materials. In 2003, in response to reports from across the nation concerning Medicare fraud and to address specific and widespread abuse by companies involved in the sale of power mobility scooters for seniors, Congress directed the Centers for Medicare and Medicaid Services (CMS) to develop new guidelines and quality standards for suppliers of durable medical equipment, prosthetics, orthotics, supplies (DMEPOS). Congress's objective for the agency was to address fraud and waste in the program while preserving Medicare beneficiaries' convenient access to DMEPOS supplies, and to maintain established provider/patient relationships. Over the last 5 years, the AOA has actively monitored CMS's development of new DMEPOS regulations and, as necessary, raised objections — both separately and as part of a large coalition of health provider groups — about unintended consequences that would harm ODs and their patients. In 2006, after a sustained campaign led by AOA and other provider organizations, CMS officials reversed course and announced that physicians (including ODs) would not be required to participate in a new DMEPOS competitive bidding process that the agency had announced as a requirement 9 months earlier. This has meant that "prosthetic devices that aid vision (glasses and contacts) are not among the items and services subject to competitive bidding," a major regulator victory for optometry. In January 2008, CMS issued new proposed regulations concerning DMEPOS supplier enrollment. Although the AOA had earlier urged CMS officials to avoid a "one size fits all" approach to accreditation for DMEPOS suppliers and to fully recognize the unique role of licensed health providers like ODs, that's just what the agency did. CMS' plan would impose unrealistic and unworkable accreditation requirements on physician suppliers for whom DMEPOS products — while essential to patient care — are a relatively small share of services. Since the January announcement, the AOA — joined by the American Medical Association and groups representing ophthalmologists, orthopedic surgeons, podiatrists, occupational therapists and physical therapists — have opposed the final implementation of this regulation based both on its substantive deficiencies and its unworkable timeframe. Following two joint statements to CMS officials and an initial meeting with them on April 16th, the AOA and the like-minded groups have pushed for a follow-up meeting at CMS headquarters that is now set for May 16th. In addition, the AOA has briefed concerned Members of Congress on the supplier enrollment issue and will provide testimony at two upcoming Capitol Hill hearings called to examine the disconnect between Congress's directives to CMS and the impact of DMEPOS regulations on physicians. The AOA's message to CMS and concerned Members of Congress remains clear: With burdensome new supplier regulations, ODs — as well as a range of other health providers — could be faced with being unable to provide Medicare-covered DMEPOS products to their patients at the point of care. As such an outcome would prove to be harmful to physicians and patients, it must be avoided through revised regulations. AOA members with questions or concerns about this are asked to contact Kelly Hipp, AOA Director of Professional Relations, at 1-800-365-2219 x1346 / khipp@aoa.org. NPI Almost Here for Medicare Fee For Service ProvidersFrom AOA: May 23rd is Days Away - Are you Prepared? As of May 23, Medicare FFS will require and send NPI-Only in ALL provider identifier fields for all HIPAA and paper transactions where a provider identifier is required. If you send Medicare a transaction with a Medicare legacy identifier in any of the provider fields, your claim will be rejected. These transactions include all electronic and paper claims (837I, 837P, NCPDP, DDE and paper CMS-1500 and UB-04), the 276/277 claims status transaction, the 270/271 eligibility transaction, 835 remittance advice and SPR paper remittance. Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
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