MLN Matters® Number: MM7014 Related Change Request (CR) #: 7014
Related CR Release Date: July 30, 2010 Effective Date: January 1, 2011
Related CR Transmittal #: R741OTN Implementation Date: January 3, 2011
Home Health Agencies (HHAs) Providing Durable Medical Equipment (DME)
in Competitive Bidding Areas
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 & 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 inappropriate payment
of competitively bid DME items to HHAs. Make certain your billing staffs are aware
of these changes.
Background
Beginning January 1, 2011, in a 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 the 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 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 area.
• 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 of 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 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) website at 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.