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Latest News from CMS for Providers Affected by Hurricanes Harvey and Irma

Posted on in Billing/Reimbursement, Disaster Relief

From Ronda Buhrmester and Dan Fedor, VGM Reimbursement Specialists

How to Handle Replacement Equipment

CMS released guidance for DMEPOS suppliers for handling patients who have had DMEPOS items destroyed due to hurricanes Harvey and Irma.

The Medicare-enrolled supplier does NOT need to gather new documentation, such as the order, office visit, etc., to prove the medical need. The enrolled supplier is allowed to dispense a new DME item such as oxygen equipment, CPAP machine, hospital bed, wheelchair, prosthetic limb, etc. without having to get a new order and new office visit.

Here are the steps for submitting the claim for payment:

  • You need to include a narrative description on the claim that indicates what happened – e.g., “destroyed, irreparably damaged due to results of Hurricane Harvey or Irma.”
  • Use modifier RA for replacement equipment.
  • Use modifier CR for catastrophe/disaster related.
  • Use any other necessary modifiers for capped rental claims, IRP claims, oxygen claims, etc.  

A new capped rental period will begin for these items, and a new rental period will begin for the oxygen equipment as well.

If the beneficiary is located in a competitive bid area (CBA), a contracted supplier must be used. CB contracted suppliers: Please note that you are able to subcontract with a Medicare-enrolled supplier including subcontracting to your own company.

Click here for hurricane information from CMS.

RAC News for Texas and Louisiana Providers

CMS has issued a contractual guidance to the RACs regarding Hurricane Harvey and its impact to the states of Texas and Louisiana. Effective Sept. 1, the RAC’s will not send medical review additional documentation requests (ADRs) to any providers in Texas and Louisiana for a period of 30 days. 

In addition, the RACs will not send ADRs or deny claims for providers in the zip codes which have been designated by the Federal Emergency Management Agency (FEMA) as eligible for direct federal assistance for an additional 30 days (for a total of 60 days). 

This applies only to counties with FEMA major disaster declarations eligible for direct federal assistance as of Sept. 1 (not counties with emergency designations or other declarations). Information by state and county is available on the FEMA website.

Specific impacted counties in Texas include Aransas, Bee, Brazoria, Calhoun, Chambers, Colorado, Fayette, Fort Bend, Galveston, Goliad, Hardin, Harris, Jackson, Jasper, Jefferson, Kleberg, Liberty, Matagorda, Montgomery, Newton, Nueces, Orange, Refugio, Sabine, San Jacinto, San Patricio, Victoria, Waller, and Wharton. Please see https://www.fema.gov/disaster/4332 for additional information.

Regarding Louisiana, per FEMA’s website, as of Sept. 1, no counties in Louisiana were designated by FEMA as eligible for direct federal assistance.

Visit the recovery auditor's website for more information.

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Thank you for your support!

For further questions, please reach out to your reimbursement team at VGM.

Ronda Buhrmester
ronda.buhrmester@vgm.com
217-493-5440

Dan Fedor
dan.fedor@vgm.com
570-499-8459