Palmetto GBA is a Medicare Contractor for a variety of provider types (Durable Medical Equipment/Suppliers, Physicians, Hospitals, Home Health and Hospice, etc.).

As a Medicare contractor, we realize the impact Hurricane Katrina may have on the provider community we service. We will provide assistance to providers impacted by the hurricane so that they may continue to provide services to the Medicare beneficiary community and consider those services for reimbursement.

Durable Medical Equipment/Medical Supplies

• Lost or destroyed equipment - equipment is replaceable (replacement value)
• Supplies that are lost or destroyed, beneficiary may have to evacuate - beneficiary may pick up supplies before next month's drop shipment

Please note: Palmetto GBA will accept paper claims for those providers who have been affected by the recent hurricanes. Please indicate at the top of the claim in bold letters, "Disaster Claim" and the supporting documentation stating the nature of the disaster "Flood Claim." The hardcopy claims will be subject to the 28 day payment floor, which is a HIPAA requirement for hardcopy claims.

Hurricane Katrina Disaster Claims - 9/6/2005 UPDATE

In servicing beneficiaries that have been impacted by Hurricane Katrina, suppliers are facing dilemmas regarding beneficiaries that have relocated from affected areas and are now contacting new suppliers for their supplies and/or durable medical equipment. Not only do the new physicians and suppliers not know these beneficiaries, but they cannot get in touch with the original suppliers and physicians to obtain such information as certificates of medical necessity (CMNs), detailed written orders, etc.

Suppliers are reminded to exhaust all avenues to obtain medical documentation as outlined by the local coverage determination of the item being billed. If required documentation cannot be obtained, suppliers can dispense the item(s), submit a claim for the item, and obtain the necessary documentation at a later date. Please note that this procedure should ONLY be followed when servicing beneficiaries that have been impacted by Hurricane Katrina.

Suppliers should submit these claims hardcopy, and should indicate at the top of the claim in bold letters, "Disaster Claim" and include a statement regarding the nature of the disaster, i.e, "Hurricane Katrina".

Provider Reimbursement

Palmetto GBA is committed to assisting all those areas affected by this devastating situation. Assistance is available for the following:

Providers experiencing delays in the submission of their claims may request an accelerated payment. The request should be mailed or faxed directly to:

Palmetto GBA
Provider Reimbursement (CA-106)
34650 US Hwy 19 N Ste. 202)
Palm Harbor, FL 34684-2156 )
Attn: Clayton Hatfield)
Fax: (727) 771-7838 )
Phone (727) 773-9225, extension 15660

If you are unable to submit your March 31 or April 30, 2005 cost report, you may request an extension of the cost report due date. By requesting an extension, you will be preventing any disruption of claim payments. This request should be mailed or faxed to:

Palmetto GBA
Provider Reimbursement (AG-330)
2300 Springdale Drive, Building One
Camden, SC 29020
Attn: Dinah McFadden
Fax: (803) 935-0262
Phone: (803) 382-6189

Providers experiencing delays in the submission of their claims may request an accelerated payment. The request should be mailed or faxed directly to:

Palmetto GBA
Provider Reimbursement (CA-106)
34650 US Hwy 19 N Ste. 202
Palm Harbor, FL 34684-2156
Attn: Clayton Hatfield
Fax: (727) 771-7838
Phone (727) 773-9225, extension 15660

If you are unable to submit your March 31 or April 30, 2005 cost report, you may request an extension of the cost report due date. By requesting an extension, you will be preventing any disruption of claim payments. This request should be mailed or faxed to:

Palmetto GBA
Provider Reimbursement (AG-330)
2300 Springdale Drive, Building One
Camden, SC 29020
Attn: Dinah McFadden
Fax: (803) 935-0262
Phone: (803) 382-6189

The following are CMS instructions to contractors for granting administrative relief from medical review in the presence of a disaster. These excerpts are taken from the Medicare Program Integrity Internet Only Manual (IOM) 100-8.

IOM 100-8 Medicare Program Integrity
Chapter 3

3.2.2 - Administrative Relief from Medical Review in the Presence of a Disaster
(Rev. 71, 04-09-04)

When a disaster occurs, whether natural or man-made, contractors should anticipate both an increased demand for emergency and other health care services, and a corresponding disruption to normal health care service delivery systems and networks. In disaster situations, contractors should do whatever they can to assure that all Medicare beneficiaries have access to the emergency or urgent care they need. Contractors should let providers know (via website, responses to provider calls, etc.) that the provider's first responsibility, as in any emergency, is to provide the needed emergency or urgent service or treatment. Contractors should assure providers that they will work with providers to ensure that they receive payment for all covered services. The administrative flexibility available to contractors is discussed below. These actions will prevent most inappropriate denials and subsequent appeals.

A. Definition of Disaster

"Disaster" is defined as any natural or man-made catastrophe (such as hurricane, tornado, earthquake, volcanic eruption, mudslide, snowstorm, tsunami, terrorist attack, bombing, fire, flood, or explosion) which causes damage of sufficient severity and magnitude to:

1. partially or completely destroy medical records and associated documentation that may be requested by the contractor in the course of a Medicare medical review audit,
2. interrupt normal mail service (including US Postal delivery, overnight parcel delivery services etc.), or
3. otherwise significantly limit the provider's daily operations.

A disaster may be widespread and impact multiple structures (e.g., a regional flood) or isolated and impact a single site only (e.g., water main failure). The fact that a provider is located in an area designated as a disaster by the Federal Emergency Management Act (FEMA) is not sufficient in itself to justify administrative relief, as not all structures in the disaster area may have been subject to the same amount of damage. Damage must be of sufficient severity and extent to compromise retrieval of medical documentation.

B. Basis for Providing Administrative Relief

In the event of a disaster, contractors may grant temporary administrative relief to any affected providers for up to 6 months or more with good cause. Administrative relief is to be granted to these providers on a case-by-case basis in accord with the following guidelines:

• Contractors must make every effort to be responsive to providers who are victims of the disaster and whose medical record documentation may be partially or completely destroyed.
• Providers must maintain and, upon contractor request, submit verification that (1) a disaster has occurred and (2) medical record loss resulted from this disaster to the point where administrative relief from medical review requirements is necessary to allow the provider sufficient time to obtain duplicate, lost record, or reconstruct partially destroyed records.

Verification of the disaster and the resultant damage may include but is not limited to: (1) copies of claims filed by the provider with his/her insurance and liability company, (2) copies of police reports filed to report the damage, (3) copies of claims submitted to FEMA for financial assistance, (4) copies of tax reports filed to report the losses, or (5) photographs of damage. Contractors should not routinely request providers to submit verification of damage or loss of medical record documentation.

C. Types of Relief Providers Directly Impacted By Disaster

When a provider who has been selected for complex pre or post pay review is directly affected by a disaster, the contractor should consider shifting the time period of the claims being reviewed to a later time period (e.g. 6 months later). Additional Documentation Requests (ADRs) should be suspended for providers who have been directly affected for at least 30 days. These claims should not be denied as non-covered and may be tagged for later post pay review. Contractors should consult with their regional office prior to shifting the time period of review or suspend ADRs for certain providers.

Contractors should allow up to an additional 6 months beyond the original due date for the submission of requested records. Requests for extensions beyond this date may be granted with good cause at the discretion of the contractor.

In the case of complete destruction of medical records where backup records exist, contractors must accept reproduced medical record copies from microfiched, microfilmed, or optical disk systems that may be available in larger facilities, in lieu of the original document. In the case of complete destruction of medical records where no backup records exist, contractors must accept an attestation that no medical records exist and consider the services covered and correctly coded. In the case of partial destruction, contractors should instruct providers to reconstruct the records as best they can with whatever original records can be salvaged. Providers should note on the face sheet of the completely or partially reconstructed medical record: "This record was reconstructed because of disaster."

Providers Indirectly Impacted By Disaster

For providers that are indirectly affected by a disaster (e.g., an interruption of mail service caused by a grounding of US commercial air flights), contractors must take the following actions:

• For prepay or post pay documentation requests, extend the parameter that triggers denial for non-receipt of medical records from 45 days to 90 days. ADR letters must reflect that the response is due in 90 days rather than 45 days. This action will prevent most inappropriate denials and unnecessary increases in appeals workload.
• If a contractor receives the requested documentation after a denial has been issued but within a reasonable number of days beyond the denial date, the contractor should REOPEN the claim and make a medical review determination. Many contractors believe that 15 days is a reasonable number of days although contractors should make these decisions on a case-by-case basis. The workload, costs and savings associated with this activity should be allocated to the appropriate MR activity code (e.g., prepay complex or post pay complex review).

Contractors should conduct these re-openings retroactively back to the date of the disaster.

D. Impact on Data Analysis

Contractors` data analysis should take into consideration the expected increase in certain services in disaster areas.