decisionhealth Newsletters, Coder Pink Sheets - 2010 Issue 3 (March)
DME claims to require patient ZIP; PECOS rule put off to 2011
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Article Overview
This article covers a CMS transmittal and related Medicare billing guidance affecting durable medical equipment claims and provider enrollment verification. It is relevant to DME suppliers, Medicare billing staff, and compliance teams who need to track claim-data requirements, denial reason/remark codes, and a postponed enrollment-database deadline.
Why This Topic Matters
The article highlights claim-element changes and a delayed Medicare enrollment requirement that can affect whether DME-related claims are accepted or denied. Readers need this information to follow current CMS administrative requirements and avoid preventable claim rejections.
Article Sections
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DME claim ZIP code requirement
Explains a CMS update to Medicare billing data requirements for durable medical equipment claims and the administrative reason for the change.
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Denial codes used for missing ZIP information
Identifies the claims-processing codes CMS directed contractors to use when required address information is missing or incomplete.
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PECOS enrollment deadline delay
Summarizes the postponed effective date for the provider enrollment database requirement and the general claim types affected by the rule.
What You Will Learn
- What CMS changed for DME claim submission data
- How Medicare contractors were instructed to handle certain missing-information denials
- What enrollment-database requirement was delayed and when the new date applies
- Which Medicare billing areas are affected by the CMS guidance
Who Should Read This
- Durable medical equipment suppliers
- Medicare billing and reimbursement staff
- Compliance officers
- Healthcare practice managers
- Medical coders and billers
Codes Discussed
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