Search Frequenty Asked Questions

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Information Resource for Medicare

Highlights

Stay Informed - Go to CMS Mailing Lists to join a provider specific listserv (or electronic mailing list service) to receive news from CMS.

Billing

AdminaStar

Cigna

HealthNow

Palmetto GBA

Consolidated Billing for Skilled Nursing Facility (SNF) Residents Claims Billed to Medicare Carriers or DMERCs by Physicians, Non-Physician Practitioners, and Suppliers

Electronic Data Interchange (EDI)(Billing) Medicare information on electronic transactions under HIPAA

CMS Manuals and Transmittals

• CMS Manual System (Internet-Only Manuals) -- Effective October 1, 2003, CMS transitioned from a paper-based to a web-based manual system.
• Program Transmittals
• DMEPOS Program Transmittals
• DMEPOS Program Memoranda
  2003   2002   2001
• Medicare Policy Benefit Manual (Chapter 15, Section 110)
• Medicare Claims Processing Manual (Chapter 20 - Durable Medical Equipment, Prosthetics, Orthotics and Supplies)
• Carrier and Intermediary Manual -- Crosswalks from Paper-Based Manuals to Internet-Only Manuals

Medicare National Coverage Determinations Manual

• Durable Medical Equipment Reference List (Section 280.1)

Payment

DMERC Fee Schedule

Advanced Beneficiary Notice (ABN)

• ABN Form (CMS-R-131)

Certificates of Medical Necessity (CMNs)

DMERC Information Form (DIF)

Home Health Prospective Payment System

DMERC Supplier Manuals

AdminaStar

Cigna

HealthNow

Palmetto GBA

Enrollment/Participation

DMEPOS Enrollment

National Supplier Clearinghouse contains information about supplier enrollment

About Medicare Participation

Participating Suppliers Directory which suppliers accept assignment for DMEPOS by state

CMS 855 Enrollment Form

Coding

Procedures For Coding and Payment Determinations For Clinical Laboratory Tests and For Durable Medical Equipment

Healthcare Common Procedure Coding System (HCPCS)

Alpha-Numeric HCPCS File

ICD9-CM Coordination and Maintenance Committee
This site includes links to the ICD-9 codes

ICD-9 Coding Resources on Medlearn

Policies/Regulations

Medicare Modernization Act

Code of Federal Regulations

Social Security Act

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Quarterly Provider Update

Coverage

Medicare Coverage Homepage

Medicare Coverage Database contains National Coverage Determination(NCDs), National Coverage Analyses(NCAs), and Local Medical Review Policy (LMRPs)

Medicare National Coverage Determinations Manual

Medicare Secondary Payer

Medicare Secondary Payer Manual

Medicare Coordination of Benefits

Competitive Bidding

Competitive Bidding Demonstration

Medicare Competitive Acquisition for Certian DMEPOS

Education

Medicare Learning Network (Medlearn): using the Internet as a learning resource

• Medlearn Matters...Information for Medicare Providers -- Articles are designed to help providers understand new or changed Medicare policy.

Frequently Asked Questions

DMERC Websites

• CIGNA
• AdminStar Federal
• HealthNow
• Palmetto GBA

Program Integrity/Medical Review

Chapter 5- Program Integrity Manual - Items and Services Having Special DMERC Review Considerations

Chapter 12- Program Integrity Manual - FI, Carrier, DMERC and RHHI Interaction and Coordination with Program Safeguard Contractors (PSCs)

Fighting Fraud & Abuse

Medicare Medical Review Program

Medicare Integrity Program

Local Medical Review Policies

Contacts

DMERC Directory (Adobe PDF 62Kb)

SADMERC Helpline: (877) 735-1326
Who you should contact to determine which HCPCS code to use for billing

Regional Office Contacts

• spelella@cms.hhs.gov (Region A DMERC - philadelphia RO)
• jcampbell@cms.hhs.gov (Region B DMERC - Chicago RO)
• mdaniels@cms.hhs.gov (Region C DMERC - Atlanta RO)
• lborelli@cms.hhs.gov (Region D DMERC - Denver RO)

CMS Regional Office Directory - General

Contact your Carrier/FI via Toll-Free Numbers and Websites
A listing of the new toll free numbers that CMS has installed at Medicare contractor sites

How To Stay Informed

Listservs

Open Door Forums

Press Releases

Quarterly Provider Update