*This is an archive page. The links are no longer being updated. 

1993.
11.04 :  New Carriers for Medicare DME Claims

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Contact: Anne Verano 
Thursday, Nov. 4, 1993 
(202) 690-6145

     The Health Care Financing Administration has transferred seven
states into a new regional arrangement to handle Medicare claims
filed by suppliers for the multibillion-dollar durable medical
equipment industry.
     The seven states are Connecticut, Idaho, Indiana, Montana,
Rhode Island, South Carolina and Washington.
     With this action, effective Nov. 1, HCFA begins a national
changeover to four regional carriers to handle DME claims.  All
other states will be phased into the new setup on a schedule that
begins Dec. 1, and extends through March 1, 1994.
     Last year, the four regional carriers were selected
competitively to provide greater efficiency, and to combat fraud,
waste and abuse in Medicare claims filed by the DME industry. 
Previously, DME suppliers' claims were processed by one of the 33
current Medicare carriers that continue to handle claims from
physicians and outpatient facilities.
     "By having regional carriers, we will move to a more efficient
system," said HCFA Administrator Bruce C. Vladeck.  "This will save
money and will prevent our Medicare beneficiaries from being
cheated by unscrupulous suppliers."
     Under the new arrangement, it is anticipated that specialized
personnel can process claims more accurately, and reduce
differences in coverage decisions.  The regional carriers also can
cross-check claims more easily for possible fraud.
     The DME industry accounted for an estimated $2.3 billion in
Medicare expenditures in fiscal year *This is an archive page. The links are no longer being updated. 

1993.
  The new regional
carriers will process DME claims for items such as wheelchairs,
walkers, home oxygen equipment and supplies, other devices and
supplies to treat respiratory conditions, braces and artificial
limbs, home dialysis supplies and equipment, surgical dressings,
casts, immunosuppressive drugs, and intravenous feeding equipment
and supplies.
     About 50 major suppliers volunteered to send their claims to
the regional carriers ahead of the schedule.  Carriers will certify
the suppliers' readiness to use electronic billing before the
change occurs.
     HCFA has delayed completion of the phase-in until March 1, to
allow additional time to develop medical review policies and to
address concerns raised by DME suppliers that they cannot make
computer system changes in time.
     "Suppliers need more time to get their data processing systems
in line with those of the four regional carriers," Vladeck said.
     The change to regional carriers will not affect Medicare
beneficiaries.  During the transition period, the regular Medicare
carrier will answer beneficiary questions about DME claims or tell
beneficiaries how to contact their new regional carriers.