WASHINGTON, D.C. – Earlier this month, AAHomecare shared news that the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Directors published updated Medicare guidelines regarding PAP and respiratory assist device (RAD) supplies.
In the Dear Physician Letter, the DME MACs provided guidelines on completing the Standard Written Order (SWO) for supplies, encouraging physicians to use general descriptions for the description of the item like “CPAP Mask” or “Mask – Fit to Comfort” to accommodate mask variations without requiring a new SWO for each change. This flexibility has been requested by AAHomecare for many years, and we are pleased that the DME MACs listened to the supplier community to streamline paperwork.
“While the journey to allow PAP supply ‘general descriptions’ has been arduous, its impact on suppliers, physicians and patients is nothing short of transformative,” noted AAHomecare’s Regulatory Council Chair, Missy Cross. “This triumph not only streamlines processes but also heralds a new era of efficiency and collaboration.”
In addition to the publication, a DME MAC confirmed separately with AAHomecare that the updated guidelines applies to all supplies such as tubing and nasal pillows. Effective date for this change is Feb. 1, 2024. AAHomecare expects that additional info will be forthcoming from the DME MACs.
DME MACS Correct Erroneous Denials of 90-Day CGM Supply Claims
WASHINGTON, D.C. – Effective January 1, 2024, the DME MACS were directed to allow for 90-day billing for continuous glucose monitoring (CGM) supplies, fulfilling a long-standing request by AAHomecare. However, in mid-January, it was discovered that an edit within the DME MACS’ claims processing systems caused them to erroneously deny.
Upon notification by the supplier community, the DME MACs promptly addressed the issue for future claims and confirmed that they would auto-reprocess the claims denied in error. The DME MACs instructed the supplier community not to take any action. Payments resulting from the auto-reprocessing are anticipated to be made in the coming weeks. This remains an ongoing development, and AAHomecare will continue to monitor the situation closely.
AAHomecare extends its gratitude to the DME MACS and the supplier community for their collaborative efforts in resolving this issue.
