Medicare Contractor & CMS Regional Office Contacts

Regarding Hurricane Katrina Issues

For the quickest service, CMS asks that you please try to get your question answered/issue(s) resolved in the order listed below.

1.) First try---Contact your Medicare carrier or fiscal intermediary with questions regarding billing, coverage, and other issues. Their toll-free provider telephone numbers are listed at: http://www.cms.hhs.gov/medlearn/tollnums.asp

2.) Second try, if necessary---Contact the following carrier and fiscal intermediaries (main offices) below only if you are unable to reach a customer service representative via the toll-free telephone numbers, or if they could not answer your question.

3.) Third try, if necessary---Contact the appropriate CMS regional office, only if you do not get a helpful response from the contacts above:

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.

Since Palmetto GBA services a variety of provider types, here is some general information concerning additional assistance that Palmetto GBA will give to providers that have experienced damage or an interruption to current business as a result of the recent hurricane.

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.

Home Health and Hospice Providers

Hospice providers are able to arrange core services by contracting with another hospice agency due to extraordinary situations according to the Medicare Modernization Act (MMA) Section 946, thus hospice agencies should not discharge or advise patients to revoke the Hospice Medicare Benefit. Hospice agencies are required by the Conditions of Participation (COPs) to have a disaster plan in place. Hospice agencies should arrange with other hospice agencies if patients have to leave the service area or have to leave because of a hurricane situation.

There may be other specific situations (claims selected for medical review, cost reports, overpayments, ect.) in which Palmetto GBA will provide additional assistance to providers that may have been impacted by the hurricane. To find additional helpful information, please type the word "hurricane" in the Search box at the top of this page.

Please use the following helpful telephone numbers in order to initiate contact with the Provider Service Centers at Palmetto GBA.

Helpful Telephone Numbers

Durable Medical Equipment Carrier:

Region C DMERC Voice Response Unit (VRU): (866) 238-9650
Region C DMERC (CSR): (866) 270-4909
National Supplier Clearinghouse (NSC): (866) 238-9652

CMS ACTIONS TO HELP BENEFICIARIES, PROVIDERS IN KATRINA STRICKEN AREAS

The Centers for Medicare & Medicaid Services has acted to assure that the Medicare, Medicaid and State Children’s Health Insurance Programs will flex to accommodate the emergency health care needs of beneficiaries and medical providers in the Hurricane Katrina devastated states.

Many of the programs’ normal operating procedures will be relaxed to speed provision of health care services to the elderly, children and persons with disabilities who depend upon them.

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 health care records, information on current health status or even verification of the person’s status as a Medicare or Medicaid beneficiary. CMS is assuring those facilities that in this circumstance the normal burden of documentation will be waived and that the presumption of eligibility should be made.

Federal Medicaid officials are also working closely with state Medicaid agencies to coordinate resolution of interstate payment agreements for recipients who are served outside their home states.

The agency will also offer the following relief immediately:

• 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 will be exempt from sanctions for noncompliance, unless it is discovered that fraud or abuse occurred.
• Crisis services provided to Medicare and Medicaid patients who have been transferred to facilities not certified to participate in the programs will be paid.
• Programs will reimburse facilities for providing dialysis to patients with kidney failure in alternative settings.
• Medicare contractors may pay the costs of ambulance transfers of patients being evacuated from one health care facility to another.
• Normal prior authorization and out-of-network requirements will also be waived for enrollees of Medicare, Medicaid or SCHIP managed care plans.
• Normal licensing requirements for doctors, nurses and other health care professionals who cross state lines to provide emergency care in stricken areas will be waived as long as the provider is licensed in their home state.
• Certain HIPAA privacy requirements will be waived so that health care providers can talk to family members about a patient’s condition even if that patient is unable to grant that permission to the provider.
• Hospitals and other facilities can be flexible in billing for beds that have been dedicated to other uses, for example, if a psychiatric unit bed is used for an acute care patient admitted during the crisis.
• Hospital emergency rooms will not be held liable under the Emergency Medical Treatment and Labor Act (EMTALA) for transferring patients to other facilities for assessment, if the original facility is in the area where a public health emergency has been declared.

More information about CMS emergency relief activities, including a detailed explanation of billing and payment policy revisions, and phone numbers for the state medical assistance offices can be found can be found at www.cms.hhs.gov. Frequently asked questions and their answers on the site will be updated daily by 2pm.

Georgia Association of Medical Equipment Services (GAMES)

CLICK HERE for additional information, including enrollment forms, for all three affected states.