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If we dispense a DME to a patient that has Medicare...are we required to obtain a signed delivery slip? We are in a family medicine practice. Can we bill Medicare for L3020-orthotics? Are modifiers required to be billed with the HCPCS to insurance carriers other than Medicare? Is the sticker from the DME product sufficient enough for the description of the item ordered? We supply DME during a face to face visits. Can the order be part of the provider's progress notes? Yes I will be addressing that shortly these POD (proof of delivery) need to maintained with your DME file for that patient If you use Noridian Medicare here is the link., otherwise check with your specific payer. https://www.noridianmedicare.com/dme/news/manual/cha pter3.html#6 I would call Medicare or payer to verify and ask specific requirements and remember to use correct POS That would be carrier specific you would need to check with the carrier regarding DME modifiers. If the sticker is very detailed and order specific yes. I am unclear as to who is doing the Face to face Visits. Face to face visits need to be done by provider and then submitted to the DME company. Remember place of service 11 is not a valid place of service for DME Does the slip need to be signed by the Beneficiary or can they leave it by the door? 1) Is a delivery slip required still required when it is a "noncovered supply...2) Is the supply separately payable in the ASC (non-covered supply)...3) If it is a direct expense to the physician; however stored at the "ASC", for patient convenience; can the physician bill for this supply with place of svc at "office"? You must have a signature to show proof that it was delivered to beneficiary. This is discussed through out the presentation 1) I would say if you are billing for even non covered you need proof that the beneficiary actually received the item. 2) You would need to see specific guidelines for ASC or carrier specific rules 3: DME is not valid at POS 11, ask specific carrier their policy on how they want you to handle specific devices.
Does the place of service 11 depend on the item that is given and also the insurance carrier? If a patient is hospitalized, and we are denied payment for that month, should we rebill that month with the skilled nursing facility POS code? Where can the the requirement of signature be found? Place of service is not a valid place of service, I would contact your payer and supply them the item, diagnosis and let them know you want to bill using place of service 11 and follow their specific guidelines I would read your SNF guidelines and with out knowing what equipment you are billing for I am unable to answer. If you are in the Noridian Medicare you can find them here: https://www.noridianmedicare.com/dme/coverage/checkli sts.html or check with your local Medicare carrier The patient is having face to face visits with the provider (NP/PA/MD/DO). Also, the DME are given during the visit in the office and billed with POS home. Do we need to have a proof of delivery signed by the patient? It is included on the provider's note that DME is provided during the visit. If DME is not valid at POS 11, how would an orthopod bill for supplies, such as a boot, if given to the patient at an office visit? We are an orthopedic clinic and dispense several DME's such as knee braces, ankle braces, etc., should we have the patient sign for DME's to prove they received it? If you are using place of service home and not office you are correct. I would make a log to have patient sign and state they are taking with them making sure item received is clearly defined and date and signature I would verify with the specific carrier to get their requirements. POS is where is device being used. Yes, with all the lack of proof and delivery, I would say it is good practice to make sure you have proof of delivery, even if in office
For orthotics such as L0637, We supply patients these in our office. Can you please explain more on what is appropriate for payment. I have printed the PowerPoint and there is very little on the requirements. I would clearly list all items patient is taking home using POS (home) and have patient sign to avoid issues. I would also recommend you contact specific carrier with any other carrier specific rules. If we know a supply is non-covered by Medicare and we obtain a proof of delivery slip, can the patient be billed for this supply? You have to notify patient in writing, ABN and have that filled out completely and patient must sign and mark the decision to still proceed. If you use the correct modifiers and then it is denied and you have your signed ABN then depending on denial reason it is possible. I bought a company. one of the o2 clients wasn't' being paid b/c of a recert evaluation. I've been servicing this client for almost 2 years now without reimbursement. what is needed to get this paying again? please advise? when have preformed another pulse ox to show continued need. If your carrier is Noridian Medicare here is the link for all the requirements for O2 or you will need to check with your Payer in question. https://www.noridianmedicare.com/dme/coverage/docs/ch ecklists/oxygen_and_oxygen_equipment.html Is it ok to have patients sign ABN forms even though we know it is reasonable and necessary and diagnosis matches the brace being given? Basically erring on the side of caution. Regarding your last answer...can you tell me where we can find "in writing", requirements for obtaining a signed proof of delivery slip for each supply that is dispensed. (even for non-covered supplies) I would agree with you and having patient sign, to err on side of caution. Always check up on policy changes that may have happened to make sure no changes affect your coding/billing. If you use Noridian Medicare as your carrier you can find the documentation check lists on link provided or contact your local payer for specific guidance. https://www.noridianmedicare.com/dme/coverage/checkli sts.html
Do you see any issues with any billing systems automatically changing the place of svc to home for all DME supplies? We are cigna government services, can you give me the link for them? Just to be clear...is it a good medical practice or a "requirement" to obtain a proof of delivery on any noncovered durable medical supply If we supply DME that needs multiple items, such as urinary device collection, do we have to itemized? We also do the insertion of the catheter in the office. Are Orthotics inclusive in the global surgical package? We have given braces for stabilization after spinal susions and have been denied stating as such. WE had the patient sign the DOD, as well as prvided the order. Does the order have to be the same day? If we take them to surgery. Place of service has to match if your records. To have your system automatically switch could lead to incorrect POS http://www.cgsmedicare.com/ If you use Noridian Medicare here is a Documentation Checklist, if you do not have Noridian Medicare you will need to check with your payer https://www.noridianmedicare.com/dme/coverage/checkli sts.html Yes Depending on carrier/payer rules, I would check the guidelines and LCD/NCD's as applicable. CMS Website http://www.cms.gov/regulations-and- Guidance/Guidance/Manuals/downloads/clm104c20.pdf How long can a DME bill for maintenance after the billing is capped? I would call payer in question and ask for policy guidance. CMS DME Link http://www.cms.gov/center/provider- Type/Durable-Medical-Equipment-DME-Center.html
If a patient chooses option 2 on the ABN form, choosing not to have Medicare billed for an item that is normally covered by Medicare, and chooses to pay out of pocket. Are we required to charge the patient the same amount we would have billed Medicare or is the supplier allowed to reduce the cost? Can DME be billed in an outpatient setting? For E.g. Would it be POS 11 for out patient setting for TENS unit? Face to Face requirement- Do we create our own forms as part of the internal compliance process? Or are there CMS forms that we can use? CMS Claims Processing Manual Link Chapter 20 CMS Guidelines ABN http://www.cms.gov/regulations- and- Guidance/Guidance/Manuals/Downloads/clm104c30.pdf If you click on the link provided at end it will take you to the requirements. Place of service is where the beneficiary will use the product Face to face needs to be done by beneficiary's provider and documented and sent to the DME company. You can use your own forms. http://www.cms.gov/regulations-and- Guidance/Guidance/Manuals/downloads/clm104c20.pdf