CMS has released procedures to assist those DMEPOS suppliers located in areas that have been determined by the Governor to be disaster areas.

Requests to change a “Physical”, “Mail To” or “Pay To” address or telephone number:

• Can be accepted by fax, but not by phone
• Can be on company letterhead - prefer to be submitted on the CMS 855S, if possible
• Should be signed by the authorized or delegated official
• Should include the Legal Business Name, Tax Identification Number/Social Security Number and signature of the authorized or delegated official

DMEPOS suppliers who are unable to locate the authorized or delegated official may still submit a change request, but the NSC analyst will request additional information to verify the validity of the submittal. If the NSC is unable to verify the validity of the information submitted, the request will not be processed.

Please note once the situation has stabilized, the NSC will contact those suppliers who submitted a request by fax and request the information be submitted on the CMS 855S form.

For suppliers who have documentation already in process, the NSC will attempt to contact these suppliers. Enrollment documentation that can be processed, will be completed. However, if the NSC determines the documentation cannot be processed at the time, the NSC will request the documentation be resubmitted at a later date. Once received, the NSC will make every effort to expedite the processing of this documentation.

Further, for suppliers located in disaster areas, the NSC:

• Will hold reenrollments scheduled to be mailed
• Will not inactivate supplier numbers for reenrollments already mailed or currently in process
• Will not inactivate or set an alert code for returned mail (DNF)
• Will also work with suppliers on a case-by-case basis to assist in resolving enrollment issues

To receive updates on hurricane procedures and for other information regarding enrollment, please sign up for both the CMS and NSC listserv.

National Modifier and Condition Code To Be Used To Identify Disaster Related Claims

Provider Types Affected: Physicians, suppliers, and providers billing Medicare contractors (carriers, including Durable Medical Equipment Regional Carriers (DMERCs) and/or Fiscal Intermediaries (FIs), including Regional Home Health Intermediaries) for services rendered to beneficiaries affected by Hurricane Katrina.

Provider Action Needed

This article is based on Change Request (CR) 4106, which establishes a new condition code and modifier for providers to use to indicate claims for Hurricane Katrina and other disaster victims.

To accommodate the emergency health care needs of beneficiaries and providers affected by Hurricane Katrina and any future disasters, the Centers for Medicare & Medicaid Services (CMS) has created the following new condition code and modifier, effective for dates of service on and after August 21, 2005. The new condition code is “DR (Disaster related)” and the new modifier is “CR (Catastrophe/Disaster Related).”

Background

CMS has acted to ensure that the programs will be flexible in order to accommodate the emergency health care needs of beneficiaries and medical providers in the states devastated by Hurricane Katrina. Many of the programs’ normal operating procedures have been relaxed to speed the provision of health care services to the elderly, children, and persons with disabilities who depend on the services.

Because of hurricane damage to local health care facilities, many beneficiaries have been evacuated to neighboring states where receiving hospitals and nursing homes have no access to patients’:

• Health care records;
• Current health status; or
• Verification of status as Medicare or Medicaid beneficiaries.

Note: CMS is assuring facilities and medical providers receiving Medicare beneficiaries affected by Hurricane Katrina, that the normal requirements for documentation will be waived and the presumption of eligibility should be made.

Health care providers that furnish medical services in good faith, but who cannot comply with normal program requirements because of Hurricane Katrina, will be:

• Paid for services provided; and
• Exempt from sanctions for noncompliance (unless it is discovered that fraud or abuse occurred).

New Condition Code and Modifier

To facilitate claims processing and track services and items provided to victims of Hurricane Katrina and any future disasters, CMS has established a new condition code and modifier for providers to use on disaster related claims. The new condition code and modifier are for use by providers submitting claims for beneficiaries who are Katrina disaster patients in any part of the country and are effective for dates of service on and after August 21, 2005. The new codes are the following:

• The new condition code is DR - Disaster Related
• The new modifier is CR - Catastrophe/Disaster Related

For physicians or suppliers billing their local carrier or DMERC, only the modifier (CR) should be reported and not the condition code. A condition code is used in FI billing.

For institutional billing, either the condition code or modifier may be reported. The condition code would identify claims that are impacted or may be impacted by specific payor policies related to a national or regional disaster. The modifier would indicate a specific Part B service that may be impacted by policy related to the disaster.

CR4106 instructs Medicare contractors to recognize the new condition code and modifier on October 3, 2005, if possible, but no later than October 31, 2005.

In addition to this Medlearn Matters Article, CMS regional offices will help facilitate contractor outreach regarding provider education on the use of the new modifier and condition code.

Implementation

The targeted implementation date is October 3, 2005, but no later than October 31, 2005.

Additional Information For complete details, please see the official instruction issued to your carrier/DMERC/intermediary regarding this change. That instruction may be viewed on the CMS web site. From that web page, look for CR4106 in the CR NUM column on the right, and click on the file for that CR. If you have any questions, please contact your carrier/DMERC/intermediary at their toll-free number, which may be found on the CMS web site.

CMS has announced it will allow Hurricane Katrina refugees who left capped rental items behind to begin new rental episodes for replacement equipment! Additional information on changes affecting evacuees is available and is updated daily at 2:00 PM EDT.

The availability of information on eligibility and CMN status is not as forthcoming as we were given to understand, with providers that no information would be shared unless the beneficiary was on the line. To learn as much as you can about the materials in the Common Working File, get the beneficiary on a three-way call to 866-270-4909.

You will need the beneficiary's old and new addresses, and their date of birth, at a minimum, if the HIC number is not available. Despite reports that HIPAA issues would not be allowed to prevent sharing sufficient information to facilitate getting services to evacuees, reports indicate that not everyone has gotten the word. Please report your experiences, so we can continue to work on any needed improvements.

Remember, you must file claims for hurricane victims on a paper form, (the old HCFA-1500), clearly marked DISASTER. For deliveries to any temporary residence, use the Place of Service code 04 (homeless shelter). You may file such claims without having the normally-required paperwork in advance, but you must plan on eventually obtaining essentially the same proof of medical necessity that is required for the products delivered.