As you may recall, last year the four Durable Medical Equipment Medicare Administrative Contractors (DME MACs) released a clarification on the type of information which must be included on a valid Proof of Delivery (POD). The DME MACs stated that the inclusion of the official L-code descriptor, which had been the accepted norm for years, was not sufficient enough and that suppliers/providers had to include narrative descriptions and/or manufacturer information (serial number, part number, model number, manufacturer name, brand name, etc.). As a result of this sudden shift in policy numerous providers/suppliers began to have their claims denied due to invalid PODs, which were valid prior to the DME MAC clarification.
AOPA challenged the excessive specificity of that new proof of delivery policy and the problems it posed for O&P patient care providers almost immediately and sent a letter to CMS’ Laurence Wilson, Director of Chronic Care Policy Group and Dr. Shantanu Agrawal, CMS’ Deputy Administrator and Director of Center for Program Integrity. AOPA’s letter argued that only FDA received authority from Congress to require serial numbers and other unique device identifiers, and that CMS could not enforce such a ‘de facto’ serial number requirement in the absence of explicit Congressional authority. AOPA also took the opportunity to address the issue of the new POD requirements with the comments submitted in regard to the Draft Lower Limb Prostheses Policy released in July 2015.
All of this work has paid off, as AOPA has recently learned that CMS has reversed course and will now accept the official L-code descriptors on PODs. Effective March 4, 2016 the Program Integrity Manual, specifically Chapter 4; Section 4.26.1- Proof of Delivery and Delivery Methods, has been updated and includes the following statement:
The long description of the HCPCS code, for example, may be used as a means to provide a detailed description of the item being delivered; though suppliers are encouraged to include as much information as necessary to adequately describe the delivered item.
You may view the official Change Request published by CMS here and the revised Program Integrity Manual here.
While the complete PIM indicates that “suppliers are encouraged to include as much information as necessary to adequately describe the delivered item,” PODs that include the complete HCPCS code descriptors can no longer be considered invalid resulting in a denial of the claim.
AOPA is very pleased to see a direct result of its communication efforts with top CMS officials regarding POD requirements and will continue to advocate for the equitable treatment of its members.
Questions? Contact Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.