2014 Reminders

2014 Reminders:

January 6, 2014:  PECOS

    Phase 2 of PECOS will go live on January 6, 2014 which means suppliers will start receiving CO denials forphysicians that are not PECOS certified.Here are some helpful tips to avoid those CO denials:

·Create a list of those physicians that are notPECOS certified and contact them; let them know you will no longer be able toservice their patient and cannot take future referrals until they areregistered in PECOS.

· Check tomake sure you are using the individual NPI, not the physician group NPI

· Do notuse other group NPIs such as hospitals, clinics, etc.

· Make sureyou are not using your own NPI instead of the physicians

For more information refer to the PECOS website at:


January 6, 2014: Revised CMS-1500 Form (version 02/12)

The CMS-1500 form has revised with changes including thoseto more adequately support the use of ICD-10 diagnosis codes.  The revised form (version 02/12) will replacethe version 08/05.  The revised form canbe used starting January 6, 2014 but must be implemented on April 1, 2014.

July 1, 2013:  Face to Face Encounter Requirement for Certain DME

On July 1, 2013 CMS implemented the face to face rule thatis part of the ACA which requires certain DME to have a face to faceevaluation.  The law requires thata physician must document that a physician, nurse practitioner, physicianassistant or clinical nurse specialist has had a face-to-face encounter withthe patient. The encounter must occur within the 6 months before the order iswritten for the DME.  Both the medicalrecord and detailed written order must be obtained prior to the delivery of theitem.    There is a list of 166 HCPCS codes which isattached to this article below by product category.

The law is in effect now and startedJuly 1, 2013; the delay is in enforcement which means the DME MACs are not tobe auditing on this requirement until “a date” which will be announced in2014. 

Remember, the items that have alwaysrequired a written order prior to delivery, those policies have not changed andare enforced.  Some of that equipment isTENS units, seat lift mechanism, group support surfaces, PMDs, POVS, wheelchairseating, and negative wound pressure therapy pumps. 

Suppliers should have or need to startimplementing this into your daily process and educating your referralssources.   

To review the most recent articlereleases by CMS, read the article below.

Face-to-FaceEncounter Requirement for Certain Durable Medical Equipment

HCPCSCodes by Product Category

If you have any questions on any of the above information, pleasecontact the reimbursement team:

Peggy Walker                                                    RondaBuhrmester

800-401-3643                                                     888-665-6518

peggy.walker@vgm.com                              ronda.buhrmester@vgm.com