The durable medical equipment (DME) landscape has suddenly changed with the awarding of DME contracts for Region A and Region B. Noridian and CGS have gained territory at the expense of NGS and NHIC. While the awarding of the contact is old news, the announcement of the transition and websites to provide information and assist in the transition are being rolled out.

Noridian – the New JA DME MAC

In Medlearn Matters Article 9546, the Centers for Medicare & Medicaid Services (CMS) announced the awarding of the Jurisdiction A (JA) DME contract to Noridian, with an effective implementation date of July 1, 2016. The JA DME Medicare Administrative Contractor (MAC) covers Medicare beneficiaries in Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, and the District of Columbia. Noridian is also the current Jurisdiction D (JD) DME MAC.

Noridian has set up an implementation page to guide and educate providers through the process of moving from NHIC to Noridian. Of note, in-person meet-and-greet open houses are planned throughout the region at various hotels. This marks a great opportunity to network with the new MAC!

CGS – the New JB DME MAC

Changes to the JB DME MAC were recently updated in MedLearn Matters Article 9626, also with an effective implementation date of July 1, 2016. The JB DME MAC, which was awarded to CGS, covers Medicare beneficiaries in Illinois, Indiana, Kentucky, Michigan, Minnesota, and Wisconsin. CGS has also set up a transition page as the region is transitioned from NGS.

Last Chance

Download copies of local coverage determinations (LCD) and other articles and guidance from NHIC and NGS to your Compliance Scrapbook. Rest assured that you will be happy you did when the new Recovery Auditor (RA) contracts are awarded this year (hopefully). There will be a new national RA responsible for review of DME and home health and hospice (HH&H) claims. In addition to the LCDs, don’t overlook the DME supplier manuals posted at the outgoing NGS and NHIC DME websites. There are also DME “joint publications,” which are universal among the DME MACs, so you should be able to pick them up at your old or new MAC.

Also, be sure to try the NHIC quizzes and games. There are online quizzes for oxygen, Medicare basics, and proof of delivery; it’s a great way to see if you understand the requirements. Have more time? Then download the Scrabble pages and have a staff lunch and learning activity on topics including auditing contractors, enteral nutrition, glucose testing supplies, modifiers, ostomy, oxygen, power mobility devices, standard documentation language, and therapeutic shoes. Keep these items in mind for compliance week, which is coming up in November.

Who said compliance training and education had to be boring?

About the Author

Nancy Beckley is founder and president of Nancy Beckley & Associates LLC, providing compliance planning and outsourced compliance services to rehab providers in hospitals, rehab agencies, and private practice. Nancy is certified in healthcare compliance by the Healthcare Compliance Certification Board. She is on the board of the National Association of Rehabilitation Providers and Agencies. She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities. Nancy is a familiar voice on Monitor Monday where she serves as a senior national correspondent.

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