CGS Develops New Tools for Suppliers

Posted on in Billing/Reimbursement

From the desk of Ronda Buhrmester

CGS Medicare for jurisdictions B and C has been busy designing helpful tools for suppliers. These new tools will assist suppliers with decreased denials and unfavorable decisions in audits. This will also help with the intake process for new and existing patients. While this is a jurisdiction B and C contractor, the tools can be used by those suppliers located in jurisdictions A and D with Noridian.

According to the recent CGS update on their listserv, this first tool is for those suppliers dispensing PAP devices and supplies and is a very helpful tool. CGS created this tool to be used along with the LCD and Policy Article and not as a replacement for them. This tool pulls information from the policy into one location so that you are not looking through the entire LCD for something like the frequency of replacement or if the item can be billed with similar supplies at the same time.

In addition to the description of the code(s), billing and replacement information, the PAP tool includes references to the LCD, Policy Article, and the Standard Documentation Requirements for All Claims Submitted to the DME MACs. There is also information about the top errors noted by the Medical Review department at CGS during pre-pay audits. Click here to access the PAP tool on the CGS Medicare jurisdiction B and C website.

Consolidating Billing Tool
The second tool is the consolidating billing tool to be used for those patients in a skilled nursing facility, hospice or under home health care. According to the CGS recent listserv update, this new tool was created to help suppliers determine if a particular piece of DMEPOS is payable for your beneficiary during a stay in a skilled nursing facility, enrolled in hospice, or has had a home health episode.

Suppliers are to verify if a beneficiary is covered under a Part A stay. If so, all services must be billed to the AB MAC except for certain excluded items. This is where the DMEPOS Consolidated Billing Tool comes in handy. Suppliers can use the tool to see if the item or service is billable to the DME MAC.

Verification is as simple as entering the HCPCS code in the space provided and clicking on the “Search the DMEPOS Consolidated Billing Tool” button. Here are examples of the types of results you may receive: 
Not Separately Payable
Not Covered in a SNF
Separately Payable
Separately Payable if Unrelated to the Hospice Diagnosis  

Click here to access the Consolidated Billing toll on the CGS Medicare jurisdiction B and C website.

For questions, contact Ronda Buhrmester at 217-493-5440 or [email protected]