RelayHealth Notify: Claims: CPID 2116 Sanford Health Plan: New Claims Connection

The following new CPID(s) have been added for electronic claim submission using the 4010A1 ANSI format.  Effective immediately, claims can be submitted as follows.

 

CPID	Payor Name	Claim Type	Enrollments
2116	Sanford Health Plan	Professional	No

 

Fwd: RelayHealth Notify: Claims: CPIDs 2109 AIG and 2110 American Interstate (TX Only): New Claims Connections

The following new CPID(s) have been added for electronic claim submission using the 4010A1 ANSI format.  Effective immediately, claims can be submitted as follows:

 

CPID	Payor Name	Transaction Type	Enrollments
2109	AIG	Professional	Yes
2110	American Interstate (TX Only)	Professional	Yes

Please contact the RelayHealth Support Center at (800) 527-8133 with any questions.

 

Memorial Day Schedule 2009

The offices of PC SOLUTIONS / DMEFREE will be closed on Monday, May 25th in observance of Memorial Day. We will reopen on Tuesday, May 26th at 9:00 am  EST.

 

On behalf of everyone at PC SOLUTIONS / DMEFREE we would like to wish you a safe and relaxing Memorial Day weekend.

 

if you require technical assistance or an activation code please use the following resources

 

Activation code:

http://dmefree.com/activationcodepage.htm

Software support/questions

Forum:

http://www.dmefree.com/supportforum/index.phpKnowledge database:

http://www.dmefreeserver.com/cws/c5launch.dll/kb/kb2.exe.0

Thank you

 

Mike Feldman

PCSolutions

www.dmefree.com

fax 203 413 5772

 

Looking for your own domain or website - check out 1and1.com,,

We use it, click here for more info

http://www.1and1.com/?affiliate_id=89102

 

 

 

 

Senate Finance Lists Oxygen, Wheelchairs for Potential Cuts

 

 Washington Update, May 18, 2009

American Association for Homecare

 

-  Senate Finance Lists Oxygen and Wheelchairs as Potential Cuts to Pay for Health Reform in 2009

-  Fight for HME at AAHomecare's Washington Legislative Conference, June 1-3

-  Calendar Update: June 18 Mobility Conference in Pittsburgh

 

Senate Finance Lists Oxygen and Wheelchairs as Potential Cuts to Pay for Health Reform

Today, the Senate Finance Committee released a list of revenue options for financing health care reform. The document targets Medicare home medical equipment payments for potential reduction in reimbursements but does not propose specific cuts to HME, although a press release issued by Senate Finance Chairman Max Baucus (D-Mont.) and Ranking Member Charles Grassley (R-Iowa) makes a specific reference to ensuring appropriate payments for "oxygen and power wheelchairs."

 

In Section I, titled "Health System Savings," the document discusses options for "ensuring appropriate payment," and one subsection is called, "More Appropriate Payment for Durable Medical Equipment," which describes the fee-schedule pricing mechanism used for DME in the Medicare program.  The document outlines proposed options for revising DME payments:

 

"The Office of Inspector General (OIG) at the Department of Health and Human Services has identified potentially overvalued DME items and services; some contend reimbursement for certain DME items and services are under-reimbursed. The committee will explore options to improve payment accuracy for DME items and services."

 

The OIG has stated that Medicare overpays for a number of HME items.  On April 22, 2009, Inspector General Lewis Morris told the Senate Homeland Security subcommittee on Federal Financial Management that:

 

"Prior OIG work also has found that Medicare pays too much for certain pieces of DMEPOS and related supplies, such as power wheelchairs, hospital beds, diabetic supplies, and home oxygen equipment. For example, in a 2006 report, OIG found that Medicare had allowed, on average, $7,215 for the rental of an oxygen concentrator that costs about $600 to purchase new. Additionally, beneficiaries incurred, on average, $1,443 in coinsurance charges. We determined that if home oxygen payments were limited to 13 months rather than the current 36 months, Medicare and its beneficiaries would save $3.2 billion over 5 years. In other work related to Medicare pricing, OIG currently is conducting work to examine the appropriateness of prices that Medicare pays for wheelchairs by comparing Medicare prices to suppliers' purchase prices.

 

OIG recently found that Medicare reimburses suppliers for negative pressure wound therapy pumps based on a purchase price of more than $17,000 but that suppliers paid an average of $3,600 for new models of these pumps. Negative pressure wound therapy pumps are a type of DME used to treat ulcers and other serious wounds. When Medicare first started covering wound pumps in 2001, it covered only one model, which was manufactured and supplied by one company. Medicare paid for this pump based on the purchase price as identified by that company. In 2005, Medicare expanded its coverage to include several new pump models manufactured by other companies. However, Medicare reimburses suppliers for these new pumps based on the original pump's purchase price, which is more than four times the average price paid by suppliers."

 

In their 2006 report, the OIG painted home oxygen as an overpaid item based on a study conducted that looked only at the cost of oxygen equipment.  Earlier that same year, anticipating the OIG report, the American Association for Homecare commissioned Morrison Informatics to conduct a comprehensive study of the costs of providing home oxygen therapy. The resulting Morrison study found that equipment represents only 28 percent of the cost of providing medical oxygen in the homes of Medicare beneficiaries and the remaining 72 percent of costs represent delivery, compliance, patient education, 24-hour emergency service, and other non-equipment costs.

 

The American Association for Homecare asks HME providers to remind Congress that the home medical equipment sector has already suffered unwarranted and disproportionately large cuts in recent years. These payment reductions are threatening quality and access to home medical equipment and services. 

 

"Further reductions to home medical equipment reimbursement will tear the already fragile safety net provided by homecare," said Tyler J. Wilson, president of the American Association for Homecare.  "Home medical equipment and care helps reduce the length of expensive hospital and institutional care, allowing people to remain in the comfort of their own homes."

 

Fight for HME: Join Your Colleagues at AAHomecare's Washington Legislative Conference, June 1-3

Register today and join more than 200 of your colleagues in Washington, D.C., June 1-3 for the AAHomecare Washington Legislative Conference.  This event is an important opportunity to tell your Senators and Representatives about the value of homecare and to make certain that the HME sector is part of the healthcare reform discussion. Among the speakers is Senator Arlen Specter (D-Penn.). 

 

Talking points and other material will be provided to all registrants and the American Association for Homecare will schedule Capitol Hill appointments through our appointments concierge, sponsored by VGM.  Please contact Gordon Barnes (gordonb@aahomecare.org or 703-535-1883) with any questions or special requests related to your Capitol Hill visits.  For details of the fly-in or to register, please visit http://www.aahomecare.org/cde.cfm?event=236658. 

 

Special thanks to our exhibitors and sponsors:

Aon Affinity Insurance Services, Inc.,

Brightree LLC

Brown & Fortunato,

Cailor Fleming Insurance,

Campania Management Company,

Capital Healthcare Group,
 Domos HME Consulting Group

Fisher & Paykel Healthcare,

Invacare Corporation,

Medtrade,

Pacific Pulmonary Services,

Pacware Software Development,

Philips Respironics,

Pride Mobility Products,

QS/1 Data Systems,

ResMed,

Salter Labs,

Sunrise/DeVilbiss, and

Wright & Filippis.

 

Industry Supporters:

HME News,

HomeCare Monday,

Mobility Management, and

Respiratory Management.

 

For information on sponsoring or exhibiting at this event, please contact Kim Kianka at kimk@aahomecare.org.

 

 Calendar Update

 

AAHomecare Mobility Conference, University of Pittsburgh, June 18

Changes in Medicare policy for power and manual mobility, seating and positioning, and repair services have catapulted providers into a state of confusion and at times, into financial loss. Participate in this presentation to better understand mobility, seating, and service policies and ways to maintain compliance while providing optimum qualifying products to beneficiaries. In the challenging healthcare environment before us, this program is imperative for all providers who continue to provide mobility, positioning, and repair services as well as for clinicians who evaluate and qualify patients for medically necessary durable medical equipment. 

 

Speakers will include Dr. Paul Hughes, DME medical director for Jurisdiction A, Mark Schmeler, Ph.D., OTR/L, ATP from the Department of Rehabilitation Science & Technology at the University of Pittsburgh, and Georgie Blackburn, vice president of government relations for BLACKBURN's. The program is jointly sponsored by the American Association for Homecare, the University of Pittsburgh Medical Center, and the Department of Rehabilitation and Technology at the University of Pittsburgh. The event is supported by an education grant from Pride Mobility Products.

 

CEUs will be awarded to participants attending in person or by video conference and significant time will be allotted for interactive Q&A after each presentation and at the culmination of the program. Previous audio difficulties have been fixed. The program will take place on June 18 at the University of Pittsburgh. Contact Kim Kianka at kimk@aahomecare.org for more information.

 

WE THANK OUR CORPORATE SPONSORS

 

 

American Association for Homecare

2011 Crystal Drive, Suite 725

Arlington, VA 22202

 

For more information, please call AAHomecare at (703) 836-6263. 

 

 www.aahomecare.org

 

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RelayHealth Notify: Claims: Multiple CPIDs: New Claims Connections

The following new CPID(s) have been added for electronic claim submission using the 4010A1 ANSI format.  Effective immediately, claims can be submitted as follows.

 

CPID	Payor Name	Claim Type	Enrollments
2107	Quality Health Plans	Professional	No
2108	Physicians Health Choice	Professional	No

 

MSP - Medicare Secondary Payor Article

Dear RxDME2000 and DMEFree user,

 

We hope that providing you with important articles from Medicare will help you during this tough economic environment.

 

This article is about MSP - Medicare Secondary Payer, some clients have one claim a year others 30 a month or so.  I found it answered a lot of questions in terms I could understand.

 

This was the email from- CMS CMSProviderResource

A new Medicare Secondary Payer Fact Sheet  (April 2009), which provides a general overview of the MSP provisions for individuals involved in the admission and billing procedures at provider, physician, and other supplier settings is now available in downloadable format from the Medicare Learning Network at: http://www.cms.hhs.gov/MLNProducts/downloads/MSP_Fact_Sheet.pdf

I have also attached the sheet to this email

 

Some additional information;

The way RxDME2000 and DMEFree process MSP claims is via our Real time processing system.  This is a good and bad thing,, it's good because you can send the MSP claim in real time getting back an immediate response, but it's bad becuase it's expensive. There is a $25.00 minimum per month when you send MSP claims.

If you don't send any in a month there is no charge at all.

 

But there are some additional bonus's for using the MSP real time system.  Your monthly minimum allows you up to 38 transactions ($25.00/.65=38).  You can use these transactions for

1. Real time MSP claims

2. Real time Eligibility checks - please see note below from one of our users.

3. Real time Claims

 

Real time Claims, when you have a claim that is just not getting paid its useful to process it via the Real time Claims system.  The claim is checked against the logic Medicare uses to Pay the claim, not just accept it.

 

Real time MSP - even if you do one MSP claim a month it's worth sending it electronically to get paid.

 

Real time Eligibility - this note from our client Jim Buteyn, DME biller and Accreditation consultant,  says it all

 

" the Eligibility program is an incredibly invaluable tool when it comes to MSP.  By using it, I can catch the MSP before my clients waste any time obtaining documentation, etc. and more importantly, they do not deliver only to be denied by Medicare because of MSP.  The Eligibility program prevents that from happening because it shows if the beneficiary has a MSP and the effective date of the MSP. "  You may quote me if you wish! Jim

 

 

Thank You and have a wonderful spring weekend!

 

Mike Feldman

PCSolutions

www.dmefree.com

fax 203 413 5772

 

 

 

 

 

Medicare article re Mandatory electronic billing

The following CMS article is for our clients that are currently not processing claims electronically.  Please read this article regarding Mandatory electronic billing and penalty/fines.  It appears this is in effect now, however I would say it's up to Medicare to implement.

 

If you have friends in the DME business not filing electronically send them this email!

 

just in today...click link below

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0908.pdf

 

Note from mike,

95% of our clients are filing claims electronically, Medicare's numbers are closer to 99%.    The customers that are not filing through our clearinghouse may be Printing paper claims or using free Medicare software.  

 

I would like to offer a comment regarding this.  The cost of mailing a 1500 form and waiting 27+ days for payment is unacceptable in today's tight economic times.  And entering the data into Medicare Free software and then entering it again in to the DME software is a huge waste of time and costs far more in labor than the per claim we charge.   There are many other reasons that all clients should be processing claims through our clearinghouse, which I would be happy to discuss.

 

If you are ready to start processing electronically to Medicare, Medicaid, Blue Cross and Commercial payers all through the same system, saving time and energy drop us a note at support@dmefree.com.  Don't hesitate to contact me if you have questions.

 

Thank you

 

Mike Feldman

PCSolutions

www.dmefree.com

fax 203 413 5772

 

 

 

 

PCSolutions introduces Free Upgrade - ReportWriter!

Dear RxDME2000 and DMEFree users,

 

Yesterday we introduced our newest free add on - Report Writer!   This program is available for both RxDME2000 and our simpler DMEFree program.   The download links are at the bottom of this email....

 

Here is what is important to know - Report Writer unleashes the data from your software to use in hundreds of ways.  You are not handcuffed to programmers who have backlogs of reports to make etc.  

 

The Report Writer is not a programmers tool, it was created with the end user - you in mind!   If you can type your name on a word processor then you can use the Report Writer.  Sure you can type headings but what about the data?

 

There is a simple visual data dictionary with every field you can think of available to place on the report, plus you can create sub totals, totals, sort any way you want and so much more!

 

In today's business environment and with accreditation on your doorstep  now is the time to get the reports and forms you have always dreamed of.

 

And, we don't just give you the Report writer and walk away,, we are there to help you find the fields you need,  how to sort the report and more important how to find the specific data you need on the report.  

 

What types of reports can you create?

Everything from simple Insurance file listings sorted by State to

Physicians Orders that are item specific

Doctors listing showing NPI sorted by city

List of claims / patients who have specific diagnosis and print Dr with phone#

Mail merge documents for marketing use, example letter to patients that have specific diagnosis introducing new items.

 

There isn't a day that goes by where we are not asked for a custom report and due to time constraints we cannot create reports all day.  That why there is the Report writer!  To give you the power to create!

 

And if you would like to share your reports with other software users to help their businesses, we are happy to provide them at no charge.

 

Report Writer rev 1 Download links;

for DMEFree 3.26a

 http://www.dmefreeserver.com/files/dmefrw326a1.exe

for RxDME2000 2.17a or 2.17b

 

http://www.dmefreeserver.com/files/RXDRW217B1.EXE

 

PS..... one way of knowing what's going on at PC Solutions is to periodically check our Blog at http://dmefreesupport.blogspot.com/

or go to www.DMEFree.com and select DMEFREE BLOG

 

Thank you

 

Mike Feldman

PCSolutions

www.dmefree.com

fax 203 413 5772

 

Looking for your own domain or website - check out 1and1.com,,

We use it, click here for more info

http://www.1and1.com/?affiliate_id=89102

 

 

 

 

A new tool has been created for users of DMEFREE

Dear DMEFREE software user,

 

A new tool has been created for users of DMEFREE

it is called Report Designer (we also call it Report Writer)

 

this program is only available for DMEFREE versions 3.26a

The download link is

 

http://www.dmefreeserver.com/files/dmefrw326a1.exe

 

This is not merely a quick search program, but a true report writer designed for the end user!  In other words, it's easy to use!   The program comes with a set of pre made reports that you can copy and save for your own modification or use to give you a head start on design concepts.  And when you press F1 there is a help system too, with a tutorial!

 

There are almost no limits on what type of reports you can make;  examples being

 

File listings,, sorted your way

Labels

Mail Merge documents for marketing

Forms, such as Delivery sheets, Invoices etc.

Physicians orders

 

We are giving this program to our DMEFREE users for free, it is a supported product, ReportDesigner was carefully created and tested to make sure you get real and accurate results!   If you want to share your creations with other DMEFREE users that would be awesome as well!

 

When you install it please take the time to look at the Read me document that comes up during installation.

 

Good designing,, and please contact us with questions on using the program,, if you need help getting the program to select the right records or whatever.

 

 

 

Thank you

 

Mike Feldman

PCSolutions

www.dmefree.com

fax 203 413 5772

 

Looking for your own domain or website - check out 1and1.com,,

We use it, click here for more info

http://www.1and1.com/?affiliate_id=89102

 

 

 

CPIDs 4491, 4492, 5529 Massachusetts Medicaid: New Processing System

Massachusetts Medicaid has announced that claims submitted to MassHealth will convert to their new MMIS system on May 26, 2009. 

 

RelayHealth will be implementing the changes for CPIDs 4491, 4492 and 5529 Massachusetts Medicaid to the new system on May 15, 2009.

 

 

RelayHealth has identified the following items regarding this transition to the new MMIS system:

• Provider Online Service Center (POSC) Registration is required. MassHealth has mailed providers registration letters with instructions on how to register. Please contact MassHeath at (800) 841-2900 with registration questions.

Providers MUST link RelayHealth as a subordinate no later than May 25, 2009 in order to continue claim submission after May 26, 2009.

• Providers will link User ID mhird as part of your online registration for the following transactions at www.mass.gov/masshealth/newmmis.
• 837 Professional claims
• 837 Institutional claims
• 835 Electronic Remittance Advice (ERA)

RelayHealth will begin submitting claims to the new MMIS system on May 16, 2009

Electronic claims submitted between May 16, 2009 and May 25, 2009 will be held by MassHealth for processing until implementation on May 26, 2009

June 2, 2009 will be the last day that ERA is produced from the legacy MMIS system.

June 8, 2009 will be the first day that ERA is available from the new MMIS system.

New Member ID requirements are now 12 numerics. The current 10 alphanumeric Member ID will continue to be accepted for a limited time.

Payor agreements for new providers will continue to be required for electronic claims and remittance setup.

There are no payor reports that will be returned from MassHealth.

 

 Action Required: Provider training is available at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/Providers

Thank you

Mike Feldman

PC Solutions

Modifier tool at dmefree.com - under Free Data

Modifier Finder Tool Now Available! Are you a DME MAC Jurisdiction C supplier who routinely uses modifiers in billing your claims to Medicare? If so, CIGNA Government Services has a new online tool just for you! The Modifier Finder tool has been designed to aid Medicare suppliers in using modifiers correctly. Read more...

 

Link from here

www.dmefree.com

FreeData page

 

PGBA Modifier Finder Tool

 

or available here

http://www.cignagovernmentservices.com/jc/pubs/news/2009/0509/cope9812.html

 

Thank you

 

Mike Feldman

PCSolutions

www.dmefree.com

fax 203 413 5772

 

Looking for your own domain or website - check out 1and1.com,,

We use it, click here for more info

http://www.1and1.com/?affiliate_id=89102

 

 

 

 

RxDME2000 users new tool - Free Report Designer

Dear RxDME2000 software user,

A new tool has been created for users of RxDME2000

it is called Report Designer (we also call it Report Writer)

this program is only available for RxDME2000 versions 2.17a or 2.17b .  

The download link is

http://www.dmefreeserver.com/files/RXDRW217B1.EXE

This is not merely a quickly search program, but a true report writer designed for the end user!  In other words, it's easy to use!   The program comes with a set of pre made reports that you can copy and save for your own modification or use to give you a head start on design concepts.  And when you press F1 there is a help system too, with a tutorial!

There are almost no limits on what type of reports you can make;  examples being

File listings,, sorted your way

Labels

Mail Merge documents for marketing

Forms, such as Delivery sheets, Invoices etc.

Physicians orders

We are giving this program to our RxDME2000 users for free, it is a supported product, ReportDesigner was carefully created and tested to make sure you get real and accurate results!   If you want to share your creations with other RxDME2000 users that would be awesome as well!

When you install it please take the time to look at the Read me document that comes up during installation.

Good designing,, and please contact us with questions on using the program,, if you need help getting the program to select the right records or whatever.

Thank you

 

Mike Feldman

PCSolutions

www.dmefree.com

fax 203 413 5772

 

Looking for your own domain or website - check out 1and1.com,,

We use it, click here for more info

http://www.1and1.com/?affiliate_id=89102

 

 

 

 

Friday May 8th, 2009

Our email server seems down, we hope this is a temporary situation.
We can occasionally receive email but cannot send.

Also RxDME2000 users
Keep an eye out for an email regarding
the release of our new RxDME2000 Report writer!

Enjoy the weekend

Mike

RelayHealth Notify: Claims: CPIDs 1755 and 2544 SummaCare Health Plans: Direct Connection

As part of the Direct initiative, we are pleased to announce a new direct connection with SummaCare Health Plans for processing electronic Claims. This new connection will become effective for claims submitted on and after May 06, 2009.

The CPIDs included in this new connection are:

• CPID 1755 SummaCare Health Plans - Professional
•  

 

the following items for you to be aware of with this change:

• Payor agreements for electronic claims are not required.
• The following payor reports will be available
• Summacare Health Plans Acknowledgment report
• Normalized Payor reports for the above payor will be available as soon as possible after May 06, 2009

 

RelayHealth Notify: Claims: CPIDs 4791 and 5927 Aultcare: Direct Connection

As part of the Direct initiative, we are pleased to announce a new direct connection with Aultcare for processing electronic claims. This new connection will become effective for claims submitted on and after May 7, 2009.

 

The CPIDs included in this new connection are:

• CPID 4791 Aultcare - Professional
•  

 

RelayHealth Notify: Claims: CPID 4749 TriCare For Life: New Payor Connection

The following new CPID has been added for electronic claim submission using the 4010A1 ANSI format.  Effective immediately, claims can be submitted as follows:

 

CPID	Payor Name	Transaction Type	Enrollments
4749	TriCare For Life	837 Professional	Yes