DME MACs Take Over Medical Review Functions from PSCs
It’s transition time for mobility/rehab DME suppliers billing Medicare, as the Program Safeguard Contractors (PSCs) hand over the medical review (MR) not for benefit integrity (BI) functions to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) in all jurisdictions.
As of March 1, the DME MACs have taken over the following tasks:
• Performance of MR not for BI functions as outlined in MLN Matters article 5765 and the Medicare Program Integrity Manual (PIM), Chapter 5 — Items and Services Having Special DME Review Considerations.
• Comprehensive Error Rate Testing (CERT).
• Local coverage determinations (LCDs).
• Advance Determination of Medicare Coverage (ADMC).
• Healthcare Common Procedure Coding System (HCPCS).
• Medical review not for benefit integrity claim edits.
• Probe reviews.
• Supplier education.
• Medical review of claims (not for benefit integrity purpose).
Beginning March 1, information about LCDs, HCPCS issues and medical review/supplier education will be posted on the DME MACs’ Web sites, rather than on PSC Web sites.
Effective April 1, the PSCs “will be renamed Zone Program Integrity Contractors (ZPICs),” according to MLN Matters article 5765. The PSCs will continue to carry out the benefit integrity functions.
This article originally appeared in the March 2008 issue of Mobility Management.