Third Party Programs Updates
Free Problem Solving Medicare Eyewear Supplier Webinars |
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All eye care professional that are Medicare DME Suppliers of eyewear now have a unique resource to help them navigate this cumbersome and complex filing. A new webinar series for Medicare DME (Durable Medical Equipment) Suppliers has been launched nationwide by Pamela B Fritz of Ophthalmology Resources, LLC, Clinton, CT. These free webinars are a first in the optical industry to provide information on Medicare DME specifically for Eye Care Professionals who are suppliers of eyewear for patients after cataract surgery. “DME Medicare continues to undergo many changes and up-dates”, said Pam Fritz. “Our webinars provide quick access to information and solutions for DME Eyewear Suppliers including ophthalmologists, optometrists or opticians”, she concluded. In March, Fritz test marketed the webinars offering them free nationwide. Mark A. Miller, executive director of the Professional Opticians of Florida is the moderator for the one hour live interactive presentations that are followed by 30 minutes that invites the webinar participants to ask specific questions of Fritz. The response and participation to the original test marketed webinars was overwhelmingly favorable. In order to continue to offer the program free to participants, Fritz found manufacturer support. “We are please to have Hilco and US Optical Lab as our sponsors for the next series of webinars which started in April and continue through May”, she said. “These companies realize the value of getting vital information and education in a very timely manner to ECP’s by utilizing the efficiency of today’s webinar technology”, she added. The webinar topics, schedule and links to register are:
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WEBINAR 1 |
Resolving DME Supplier Surety Bond and Enrollment (or Re-enroll) Issues
This webinar is for suppliers who need a Surety Bond, need to add a new location or enroll, re-enroll or re-activate a location. The session will cover these applications: Surety Bond, CMS enrollment (855s), Participating Provider and Electronic Funds Transfer. New Dates to be scheduled soon. Please check back. |
WEBINAR 2 |
Is Your Optical Dispensary DME Compliant? This webinar shows you how to use the internet to see if your dispensary is DME compliant. It covers NPI Registry, PTAN, Taxonomy codes, PECOS and the consumers: DME Suppliers Directory. New Dates to be scheduled soon. Please check back. |
WEBINAR 3 |
DME Claim Filing Changes and Common Claim Errors This webinar cover the changes in time line filing and the CEDI Gateway with the new NSV (National Service Vendors). Also covered are the most common errors on claims. New Dates to be scheduled soon. Please check back. |
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Important Medicare Update for Ophthalmologists, Optometrists and Opticians Starting March 24, 2011, all DME optical suppliers (Ophthalmologists, Optometrists, and Opticians) are facing increased scrutiny of their optical dispensary's qualifications as suppliers of eyewear provided after cataract surgery. Suppliers are being evaluated regarding the standards of DME compliance as determined by DMEPOS Standards. Why optical dispensaries? Optical suppliers are concerned that they are being singled out for scrutiny. This is not so. Recently, Medicare has been given a broad scope to examine fraud and abuse in the entire area of DMEPOS ( Durable Medical Equipment, Prosthetics, Orthotics and Supplies). Thus far, hundreds of millions of $ has been recovered in fraud and abuse by DME Suppliers in such areas as wheelchairs, power mobility equipment, and other DME supplies. The refractive lens category does not fall high on detection of fraud and abuse, however, all DME Suppliers have now “have been thrown under the same bus” to be scrutinized. If your practice does cataract surgery and if your optical dispensary fills eyewear prescriptions for patients after cataract surgery, Pam Fritz, of Ophthalmology Resources and Medicare reimbursement specialist strongly recommend that you maintain your eligibility as a DME supplier. Your patient’s Medicare benefits are at stake. Patients benefits after cataract surgery include a “complete pair of eyeglasses” after each surgery (some restrictions apply). If you are not a qualified DME supplier, you are required to tell your post-op cataract patients the competitors who are qualified DME suppliers. What a missed opportunity for your optical dispensary! Medicare eyewear reimbursements after cataract surgery offer excellent insurance benefits. The patient may be eligible for two pairs of eyeglasses, one after each surgery, if they meet Medicare qualifications. Don’t let your practice miss out. Some optical chains are already geared up to take care of Medicare patients. Are they telling you something? Independent practitioner’s patients should not lose out on this important opportunity to use their benefits at their doctor’s office.
Become DME Medicare compliant now. After March 25, 2011, non-compliant optical dispensaries face a $500 enrollment charge (per dispensary location) for each new enrollment or dispensary reactivation or re-enrollment. These applications will also face increased scrutiny by DME Medicare and you still may not qualify to become a DME supplier. You can avoid this by taking action NOW.
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| How do I know if my Optical Dispensary(s) may not be DME Supplier Compliant? | |
Do you have any of the following issues:
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If you answered "YES" to any of the above immediate action is required to protect your DME Supplier Status
Compliance Webinars Being Planned Now
If you are interested participating in Free Webinar by Pam Fritz on how to be in compliance before the deadline, login on to our POF Newsletter site and check the box for Medicare Update Webinar. We will inform you of the times and dates the webinar will be presented. Click here to submit your e-mail for information
DME Medicare has set March 25, 2011 as a deadline. |
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By Pamela B Fritz CMS offers Physicians/Practitioners Special Opportunity to Participate Usually the opportunity to change your status from non-participating provider to participating provider occurs once per year, from November through December 31. Due to the recent enactment of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, CMS is offering physicians and other practitioners (optometrists) a special opportunity to become participating (PAR). This is only for physicians/practitioners whose current PAR status is non-participating. Announced on June 28, 2010 the opportunity is available only through July 16, 2010. If you wish to become a participating provider, download and complete the Medicare Participating Physician or Supplier Agreement (Form CMS-460) from their website: http://www.cms.gov/cmsforms/downloads/cms460.pdf Any new CMS-460 form received during this limited enrollment period will be retroactive for claims with dates of service Jan 1, 2010 and after. However, this will only apply to new claims received after your status as a PAR provider is processed. Remember, your CMS-460 form to become a participating provider must be post-marked on or before July 16, 2010. |
PECOS Deadline Approaching Act Now - Prevent Payment Interruption Now is the time to make sure your ordering/referring providers are enrolled in Medicare's Internet based PECOS (Provider Enrollment Chain and Ownership System). The deadline for compliancy is Jan 3, 2011. To find out if your physician and non-physician (optometrist) provider's information is in PECOS, review the list released by CMS of physician and non-physician providers who are eligible to order and refer in the Medicare program. The list is alphabetical with the first and last name and NPI. Suppliers can access the list at www.cms.hhs.gov/MedicareProviderSupEnroll Click "Ordering/Referring Report" to view the list. Suppliers should check to see if their internal and external, "outside" referring providers are listed. If your internal providers are not listed, the provider will have to update their information in PECOS. As a Supplier, you cannot do this for the provider unless the provider has authorized you through CMS. If an outside referring providers is not listed in PECOS, you should contact them and let them know that you will be unable to fill the Rx's of their referred post-op cataract patients until they update their PECOS enrollment. Contacting outside referring providers can be a sensitive issue. Several of the DME MAC contractors have a sample letter for contacting outside providers which you can modify to fit your needs. Search "PECOS" at your DME contractor's website. NHIC MAC A: www.medicarenhic.com Noridian MAC D: www.noridianmedicare.com NGS MAC B: www.ngsgovernmentservices.com CIGNA MAC C: www.cignagovernmentservices.com After Jan 3, 2011 the DME supplier's claims with ineligible referring providers will be denied. Claims filed electronically will receive notification of the denial. Paper claims will not be paid and no notification will be issued. |
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Top 6 DME Supplier Registration Mistakes Resulting in Claim Denials 1. The optical dispensary does not have it's own NPI (National Provider Identifier). The optical is the DME Supplier, not the practitioner or the group practice. The optical usually should be registered as its own organization with a separate NPI. 2. A PTAN (also referred to as Medicare supplier number or Legacy number) is not linked to your NPI. Your PTAN must appear in the NPI Registry (https://nppes.cms.hhs.gov/) with your NPI information under the "Other Provider Identifier" section in order for your NPI to crosswalk to your Medicare supplier number or PTAN. 3. Your PTAN has lapsed. CMS requires that DME Suppliers renew their PTAN numbers every three years. Many DME Suppliers have mistakenly thought that with the advent of NPI’s, keeping their DME Supplier number (PTAN) current was not necessary. If your DME Supplier Number/PTAN has lapsed, you will need to re-activate or re-enroll with NSC (National Supplier Clearinghouse) 4. You optical does not have a Surety Bond. With few exceptions, most DME Optical Suppliers need a Surety Bond. 5. The name of the Optical DME Supplier provided in the NPI Registry and the TIN (tax identification number) provided do not match. The exact name of your optical as reported to the IRS must be used in the NPI registry. 6. If you have multiple DME Optical Supplier locations, each location MUST have a separate PTAN (Medicare NSC Supplier number) and a separate NPI. |
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January, 2010Surety Bond for DME Optical Dispensary SuppliersBy Pamela B Fritz While initial directives from CMS (Centers for Medicare and Medicaid Services) seemed to indicate that physicians who provided eyewear(eyeglasses & contact lenses) to their post-op cataract patients were exempt from the requirements of a surety bond, clarifications have proven otherwise. The National Supplier Clearinghouse (NSC) has issued guidance that interpreted the statutory language from the Federal Register (January 2, 2009, 42 CFR Part 424.57 (c) (26) and 424.57(d), “All existing DMEPOS suppliers subject to the bonding requirements shall submit a copy of the required surety bond to the NSC no later than October 2, 2009”. The NSC guidance’s contradict CMS’ indications that persons receiving post-cataract eyewear are considered the ophthalmologist’s patients, regardless of whether or not they had cataract surgery performed by that practice.
It is important to note that these guidelines apply whether or not you are a participating DME provider. All Durable Medical Equipment (DME) Suppliers must conform to the Medicare DMEPOS Supplier Standards in order to retain their billing privileges. For a copy of the 26 supplier standards (short version) go to www.palmetto.gba.com You can download both the long or short versions at this site. What to do If CMS contacts you about a Surety Bond.Starting November 9, 2009, CMS began contacting DME Suppliers who had not submitted proof of a surety bond to NSC. Letters were sent to physicians, optometrists and opticians who appeared to be non-compliant because they did not submit proof of their surety bond and did not appear to meet the exemptions. The letter states that, “your Medicare supplier number…..will be revoked effective 30 days from the postmark of this letter”. It further indicated,”The supplier is barred from re-enrolling in the Medicare program for one (1) year from the effective date of revocation”. If you receive a letter from CMS, the first thing to do is make sure that your optical does indeed require a surety bond. If you fall under the previously listed requirements, then you most likely need a surety bond. Remember, you will need a surety bond for each optical location if that location is a DME Supplier (with NPI and DME PTAN). Many practices make the mistake of dispensing post-op eyewear to their patients at another one of their optical locations that does not have an NPI or PTAN. The practice may think the billing can be generated from another one of their locations that has the PTAN and NPI. This is incorrect and will cause claim rejection. If you have already acquired a surety bond before the October 2, 2009 deadline, then you should immediately email NSC: NSC.REVOCATIONS@palmettogba.com. You must send them proof that you acquired a surety bond before the Oct 2, 2009 deadline. If you acquired the surety bond after the deadline you must go through the procedure of submitting a CAP (Corrective Action Plan), along with proof of your surety bond within 30 days of the postmark of the CMS letter. Surety Bond Requirements for PTAN and NPIIf you have not acquired a surety bond and need to do so here is the process to get started. You should contact one of the sureties identified on the U.S. Department of Treasury’s listing: www.fms.treas.gov/c570/c570_a-z.html. Pam Fritz has worked with LSJ Insurance (www.lsjins.com) to secure surety bonds. These sureties are considered “authorized” sureties and are therefore the only sureties from which a bond may be obtained. All surety bond insurance companies will require you to have a valid NPI (National Provider Enumerator) number and DME Supplier number (PTAN). Be sure that these numbers are current. You must have a separate organizational NPI for your optical. Check the Registry (nppes.com) to see that the proper taxonomy code is used for “Eyewear Supplier” and that your PTAN number is entered in “Other Provider Information”. Regarding your DME Supplier number (PTAN), check to see if it is current by contacting NSC. You will need your login and password information to access your DME Supplier account. Also, go on-line to see if you are properly registered in the DME Supplier Directory (www.medicare.gov). Search “Supplier Directory” Surety Bond Application TipsSurety Bond company owner, Samir Jallad of LSJ Insurance indicates that these are the most common mistakes made on surety bond applications:
Once the surety bond application is completed processing is usually very quick. Upon receipt of the surety bond, it is important that the rest of the application process be completed as quickly as possible in order to meet CMS’s 30 day response requirement. The surety bond information must be accompanied by a CAP (Corrective Action Plan). This is a letter, on the applicant’s optical letterhead, signed by the authorized official. It should indicate that this is a “Corrective Action Plan” and state that the applicant meets all of the requirements of the “DME Supplier Standards” which now include the surety bond requirement. A copy of the surety bond documentation must be included. Mail this paperwork to: National Suppliers Clearinghouse, PO Box 100142, Columbia, SC 29202-3142 ATTN: Hearings and Appeals. NSC advises that you should allow “2 weeks for your submission documentation to show-up in the NSC”. That’s why expediting your paperwork as soon as you are contacted by CMS is so critical. It is hoped that your postmarked CAP received by NSC within 30 days of their original letter will qualify to meet their deadline requirements, regardless of how long the paperwork processing takes at NSC. If you do not meet the 30 day requirement, you still have a 60 day window to appeal the revocation decision. In this case, you must submit both a CAP and “reconsideration”. The reconsideration process will however require your presentation of your case before an “independent hearing officer” from CMS. If you do not follow up on the revocation letter with a CAP or reconsideration, or if you do not receive a favorable decision on your appeal, you must wait one (1) full year before resubmitting a CMS 855s application to be considered for re-enrollment as a DME Supplier. |
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POF Special UpdateFrom POF September 2010 Focal Point Newsletter $50K Surety Bond Requirement for Medicare Billing PrivilegesWe are very concerned and appalled as you are, that opticians were not one of the professions exempted from having to provide proof of a $50,000 surety bond in order to maintain their Medicare billing privileges. Five South Florida locations Delray to Stuart Link to contacts outside of Florida For purposes of the surety bond requirement, these sureties are considered "authorized" sureties, and are therefore the only sureties from which a bond may be obtained. Coordinated by the Opticians Association of America. we will be providing you a simple and direct way to communicate with your member of Congress about this vital issue. Stay tuned for updates and how you can be involved. |
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Medicare Surety Bond SummaryProvided by the OAA DMEPOS Surety Bond & Accreditation Requirement for Medicare Billing PrivilegesPer final regulations implemented by CMS, DMEPOS suppliers will be required to become accredited to obtain and maintain Medicare billing privileges by October 1st of this year, others may be required to post a surety bond by October 2nd to secure Medicare billing privileges and most will be required to provide both. Additional InformationFor additional information regarding DMEPOS accreditation or the provisions associated with a surety bond, go to this web site . Frequently Asked Questions (FAQs) on the surety bond requirement can be found on the NSC's FAQ page. |
Webinar Presentation Printout
"How to Fast Track Your Optical Dispensary to be a DME Compliant Supplier for Post-op Cataract Eyewear" presented by Pamela Fritz
Is Your Optical DME Compliant? PPT Printout (5/5/11)
Medicare Health Insurance Claim Form 1500 (5/9/11)
Claims Filing & Claims Errors Powerpoint (5/12/11)
Resolving Surety Bond and Enrollment Issues
(5/17/11)
Subscribe to Pamela Fritz's Medicare DME Supplier Newsletter
What You Need to Know
When You Need to Know It
To Subscribe, email pfritz@ophthalmologyresources.com
Update on Meeting
the Deadline
If you are required to get a Surety Bond and fail to do so, your optical dispensary will have its Medicare supplier number suspended and your claims for post-cataract eyeglasses will not be paid. You will be required to re-apply for a new supplier number, and any post-cataract eyeglasses dispensed until that number is issued cannot be billed to Medicare by you or by the patient.
Updates provided by: Pamela B Fritz is President of Ophthalmology Resources, LLC She serves on the Provider Outreach & Education Advisory Panels of the Medicare Durable Medical Equipment Contractors that cover the Northeast, Mid-West and Western U.S.
FAQs
Q. How and to what address do I send bond paperwork to the NSC?
A. The applicable bond paperwork should be submitted along with: (1) Section 12 of the 03/09 version of the CMS-855S and (2) a signed and dated certification statement from that application. Links to those forms are listed below (A cover letter that explains the purpose of the submission is suggested, but not required.) If the supplier has multiple locations, it may submit one set of bond paperwork, one certification statement, etc., encompassing all of its locations. The address to which the bond and associated CMS-855S paperwork should be sent is as follows:
National Supplier Clearinghouse
P.O. Box 100142
Columbia, SC 29202-3142
For the complete CMS-855S Application (39 pages)
Required Sections only 12 & 15
(5 pages)
Q. Are non-participating ("non-par") DMEPOS suppliers subject to the bond requirement to the same extent as participating DMEPOS suppliers?
A: Yes. A DMEPOS supplier is not exempt from the bond requirement merely because it is "nonpar."
Q: How does an optometrist or ophthalmologist who dispenses eyeglasses qualify for the physician exemption?
A: An optometrist or ophthalmologist who dispenses eyeglasses can qualify for the physician exemption if the glasses are furnished only to his/her own patients as part of his/her own service. For purposes of this exemption, a "patient" is someone who, for instance, receives an eye exam or other diagnostic test from the physician prior to receiving the glasses. The term "patient" does not include, however, a person who walks into the physician's office with a prescription for glasses that was issued by another physician and simply receives the glasses without any sort of examination or test being furnished.
The same general principle applies to an enrolled optical center owned by an optometrist or ophthalmologist. The center can qualify for the physician exemption only if: (1) the shop and the physician's practice are under/within the same TIN and business structure (e.g., part of the same corporation), and (2) the glasses are furnished only to the optometrist/ophthalmologist's own patients as part of his/her own service. The term "patient," again, would not include a person who enters the optical center with a prescription for glasses that was issued by another physician and simply receives the glasses without any sort of examination or test being performed by the optical center.
In order to qualify as exempt from the Surety Bond requirement, the practice must provide post-cataract eyeglasses only to its own patients. 'Own patients' have been defined as those who receive some professional service from the physician in the practice prior to receiving the glasses.
What has not been clear in the past is that the optical dispensary must be part of the same business structure (e.g., corporation) and under the same tax ID number. This may be a problem for some dispensaries that have been set up as separate entities.