Medicare dme billing programs

By law, Medicare does not have the authority to pay for generators. A supplier has been dispensing portable oxygen tanks to beneficiaries per day because power is out in their area and their oxygen concentrators do not function without power.

Can CMS provide reimbursement in addition to the fee schedule amount that the supplier is already receiving for that patient? That is, due to the above-normal amount being dispensed can payment be higher than the usual monthly oxygen payments? Answer: No, the supplier would not receive any additional payments in these situations. If a supplier chooses to provide portable oxygen equipment in lieu of stationary equipment during this time, the supplier will not receive an additional Medicare payment.

The supplier may also choose to pick up the concentrator while the beneficiary is using other stationary oxygen modalities. Answer: Absent an waiver, no. In the event that waivers are authorized for a particular emergency, specific waivers could be granted to waive the face-to-face requirement. Each request for such a waiver would be evaluated to determine if the particular circumstances warranted such a waiver.

However, in a particular emergency, specific waivers could be granted to permit DME suppliers additional time to comply with medical necessity documentation requirements.

But the requirement to submit such documentation cannot be waived altogether. How can people with Medicare who have been displaced, without access to their usual suppliers, get access to durable medical equipment, prosthetics, orthotics and supplies DMEPOS such as wheelchairs and therapeutic shoes?

Answer: Beneficiaries who have access to a telephone may contact Medicare for information regarding suppliers serving their current location. Alternatively, if beneficiaries have access to the Internet, they go to the Medicare website to obtain a directory listing suppliers by geography, proximity, and name. Answer: The Medicare monthly payment amount for oxygen and oxygen equipment includes payment for all of the different oxygen modalities concentrator, liquid, gaseous and also includes payment for portable oxygen contents.

If there is a power outage and suppliers have to switch patients to a different modality i. Therefore, no additional payment for switching to a different modality can be made in these situations as the Medicare payment includes payment for all modalities.

However, the monthly portable equipment add-on payment includes an additional payment added on to the monthly payment for oxygen and oxygen equipment when portable equipment is used and necessary. This is only an add-on payment to the monthly payment amount for oxygen and oxygen equipment and should not be confused with a monthly payment for furnishing portable oxygen equipment and oxygen contents.

Again, the Medicare monthly payment for oxygen and oxygen equipment includes payment for all modalities of stationary oxygen and payment for any necessary oxygen contents, both stationary and portable oxygen contents.

Because the Medicare statute has mandated a modality-neutral payment method for oxygen since , suppliers have not received increased payments or decreased payments depending on the type of system furnished except for the additional add-on payment for portable equipment.

Most suppliers have elected to furnish the least expensive modality over the years, an oxygen concentrator, but the Medicare payment is not a payment for this modality alone. Therefore, the statute would not allow an increased payment for situations where one modality is furnished as opposed to another other than the add-on payment for portable equipment. The portable equipment add-on payment can be made in disaster situations in cases where the patient was not already using portable oxygen equipment and needs to be furnished with portable oxygen equipment during a disaster.

However, if the patient was already receiving portable oxygen equipment, additional payments beyond what the supplier is already receiving for furnishing portable oxygen equipment on a monthly basis cannot be made because this amount includes the monthly payment amount and the add-on payment. Finally, if oxygen equipment is lost as a result of a disaster, the supplier can follow the normal process for submitting a claim for replacement of the lost equipment in disaster situations.

Medicare begins the month payment period over in situations where lost oxygen equipment must be replaced and proper documentation describing the need for replacement and the required medical necessity documentation is furnished. The DME MACs will process the claims for replacement of lost oxygen equipment using the process established for processing disaster claims. Due to the limited utilities of phone, power and internet, beneficiaries have sought a secondary provider to support their respiratory needs during the state of emergency.

We respectfully request CMS allow the secondary provider to bill for life-sustaining respiratory services rendered to a patient residing in the Hurricane Sandy-affected area. Answer: The temporary supplier of oxygen and oxygen equipment needs to seek payment from the supplier that received the Medicare monthly payment amount for the remainder of the paid month during which the beneficiary relocated or needed to obtain services from an alternate supplier.

The Medicare fee-for-service program does not authorize a duplicate payment for the same month. Due to the emergency situation, patients required the use of two oxygen dispensing modalities; portable oxygen tanks and oxygen concentrator.

Due to the lack of electricity, patients who typically utilize concentrators are requiring the use of cylinders until power is restored. In many cases, providers may already be billing for some form of portability code, whether it be K for the filling station or the E for the portable gas system. It is essential to maintain both modalities in the home environment until power is completely restored. Based upon the factors outlined, we request CMS to reimburse providers for both modalities.

Answer: If a supplier supplies liquid or gaseous cylinders in lieu of an oxygen concentrator due to a power outage, the supplier is not eligible for additional payment during this time beyond the monthly oxygen payment amount. The Medicare monthly payment amount for oxygen and oxygen equipment includes payment for all of the different oxygen modalities concentrator, liquid and gaseous and also includes payment for portable oxygen contents.

With that growth, fraud and abuse enforcement also appears to be on the rise. Recently, DME suppliers made headlines for scams that harmed vulnerable patients in the process of billing Medicare for inaccurate claims, as well as schemes for circumventing legal billing channels to overcome a lack of claims submission registration.

Certain fraudulent actions emerge as common themes in false claims act legislation. Therefore, DME suppliers should be aware of schemes that involve the semblance or actual commission of fraud. Examples include:. The government seeks to enforce false claims violations without regard to any specific provider type, including physician practices, hospital systems, and, as we explore here, DME suppliers:. Department of Health and Human Services.

The settlement resolved allegations that while the Louisiana-based company had a deactivated durable medical equipment DME supplier number, it funneled its claims to Medicare through a supplier in Texas for services rendered by SPI in Louisiana. In addition, SPI routinely waived patient coinsurance amounts over a three-year period, overcharging Medicare for the billed services. Under the False Claims Act, private citizens can bring suit on behalf of the United States and share in any recovery.

The Integrity Agreement promotes compliance with the statutes, regulations, program requirements, and written directives of Medicare and all other federal healthcare programs. Among other compliance obligations, the Integrity Agreement requires that SPI must establish and maintain a compliance program. The U. This settlement should send a message to all healthcare providers and suppliers. The call center allegedly paid illegal kickbacks and bribes to telemedicine companies, doctors, or nurse practitioners, to obtain DME orders for these Medicare beneficiaries without ever speaking to them.

Finally, they sold the orders to DME companies, who shipped out box after box of braces. The DME suppliers fraudulently billed Medicare or other insurance programs for every item. As a result, people across the US received boxes of braces they did not need or want.

The recipients were often responsible for copayments on these items, owing hundreds or even thousands of dollars! The conspiracy described in this indictment was not perpetrated by one individual.

Rather, it details broad corruption, massive amounts of greed, and systemic flaws in our healthcare system that were exploited by the defendants.

However, your business can implement several strategies to help ease the uncertainty and work towards avoiding violating the False Claims Act. First, conduct risk assessments using third-party resources to identify high-risk areas and potential threats to your business. It is integral to rely on disinterested third-party evaluations to avoid internal bias and potential missed areas of scrutiny.