I know this newsletter is longer than usual but I had a lot of time sensitive information to get out to you.  Please email me at or call 727-286-6102 if you have any questions or suggestions. 



I know that 2013 was a challenging year for our industry and I am looking forward to a successful 2014.  We are in this together and I am confident that we will all be able to adapt to the changes and find ways to grow in the New Year.  I know Regency, as well as many of our providers have found ways to ‘re-invent’ their companies to survive in a hurting industry.  Together we are finding ways to maximize reimbursement by networking together.  Regency will be offering webinars, newsletters, and training to help providers grow their business, whether it be by adding new product categories, streamlining processes, insuring compliance, or joining insurance networks.



The good news is that the Medicare Part B premium and deductible is going to remain the same.  The deductible is still $147.00 for 2014.  Medicare has also published the DMEPOS 2014 fee schedule.  Please let me know if you would like us to email or mail this to you with your end of month reports.



Unfortunately, the start date for PECOs is set for January 6, after being delayed several times.  I am still hoping for another delay but it does not look promising.  This means that claims submitted with names of physicians who are not enrolled in PECOS will be denied and the DME provider will not be paid for the item furnished.  This will definitely have an impact on your claims and we need to start preparing for this.  We are still seeing a large percentage of claims where the referring physician is not PECOS enrolled.


I would suggest checking that your referring Dr. is enrolled before providing an item.  You may do this on line on several different sites.  I have found this one to be easy to use:


Medicare has also produced a letter to physicians which explains PECOS and what they need to do.  I would suggest providing this letter to any physicians you find that are not PECOS enrolled.  Please call our office if you would like us to fax or email you a copy of the letter.



As you are probably aware, the face to face requirement is still being delayed until sometime in 2014.  The face to face rule would require health practitioners and their patients to meet within six months of writing an order for durable medical equipment.  I wanted to point out that providers still need to have a written order prior to delivery for dates of service on or after January 1, 2014.  We will keep you posted on the face to face rule. 



I know that many of you have stopped supplying diabetic supplies since the start of the competitive bidding national mail order program for diabetic testing supplies.  I just wanted to make sure everyone understands that you are not able to provide and bill Medicare for diabetic supplies unless the patient is picking them up from your store.  I also wanted to let you know that as of January 1, 2014, the policy was revised.  Providers are now allowed to bill the A4258 and A4256 with the initial issue of a glucose monitor.  This should help make up for some of the lost revenue from competitive bid pricing.




Medicare has furnished the list of 2014 HCPCS codes designated as Off-The-Shelf (OTS) orthotics.  A list is available of all new, changed, and deleted HCPCS codes that will be implemented for claims with a date of service on or after January 1, 2014.  For codes that describe orthotic and prosthetic services, there are 24 new codes, 63 codes that have had their descriptors changed and 1 code that has been deleted.  Please make sure you are reviewing these and using the correct codes.  Many services have been split into two categories; orthoses that are provided “off the shelf” with no additional fitting and training, and those that are “customized to fit a specific patient by an individual with expertise”.   The good news is the price for the OTS is the same as the ones requiring expertise.  My concern is that this might mean OTS will be included in future rounds of competitive bidding.  I made up a worksheet of these codes, the crosswalk from custom to off the shelf.  Please let me know if you would like a copy emailed to you.



As end of year approaches, now is the time to make sure you are up to date with compliance.  I suggest doing routine audits of your files and manuals to make sure everything is up to date.  You should review the guidelines of your accrediting body to make sure you are following all standards.  Make sure you are up to date with job evaluations, OIG exclusion checks, annual program evaluations, etc. I wanted to remind everyone that you should have also created new HIPAA forms to conform to the changes put in place with a deadline of September 23, 2013. Please let us know if you need help with any of this and/or if you would like a checklist of what we suggest.