This is an old CMS change regarding licensure requirements dataing back to 2005; a harbinger of practice accreditation.
CMS Change Request 3959 – How this New Change Request Affects Suppliers of O&P
Change Request (CR) 3607, which required the four DMERCs to edit claims for prosthetics and certain custom-fabricated orthotics (O&P), was rescinded and replaced by CR 3959. CR 3959 still requires the four DMERCs to edit claims for O&P, but for only those claims submitted by suppliers operating in the nine states that currently require an orthotic and prosthetic license.
The nine states which have orthotic and prosthetic licensure requirements include:
* Alabama * Florida * Illinois * New Jersey * Ohio * Oklahoma * Rhode Island * Texas * WashingtonTherefore, effective October 3, 2005 the DMERCs will begin editing O&P claims submitted with a date of service of October 1, 2005. Suppliers who do not have the proper specialty on file with the NSC will not receive payments for these types of claims.
In order to ensure suppliers of O&P receive payment, suppliers should contact the NSC Customer Service Line at 1-866-238-9652 to inquire if the proper specialty is on file. Please note, an individual listed on the supplier file should contact the NSC. If the individual is not on file, the NSC analyst will not be able to provide any supplier specific information.
If the supplier file requires updating, the supplier is required to submit a “Change of Information” on the CMS 855S form. Information on how to update your supplier file is located under the Change of Information Guide.
Please note, supplier standard #1, requires all state and federal required licenses be submitted for each specialty, product and service checked. These licenses must be attached to the “Change of Information” upon receipt prior to any updates being processed. Also note, the effective date of the new or revised specialty code for O&P will be the date the NSC issues the specialty. CMS has stated the new or revised specialty code will not be applied retroactively.
For a Medlearn Matters article regarding CR 3959, please visit http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM3959.pdf
For a list of the HCPCs codes affected, please visit http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp
To verify if the proper specialty is on file or for questions about completing a “Change of Information”, please contact the NSC Customer Service Line at 1-866-238-9652.
Copyright 2006, Palmetto GBA. All Rights Reserved.