AMERX Health Care provides extensive and detailed guidance to the AMERX Network of Physicians. This guidance covers compliance when dispensing surgical dressings and includes documentation requirements. Many providers are comfortable with the documentation that is required when initially dispensing surgical dressings. However, it is just as important to be comfortable with the regulations regarding the […]
When providing Durable Medical Equipment (DME) to Medicare Part B beneficiaries, there are certain situations where an Advanced Beneficiary Notice (ABN) may be required. An ABN should be issued to the patient before they receive DME that is usually covered by insurance but is not in this particular case. Issuing the ABN prior to delivery […]
According to the DMEMAC Local Coverage Article (LCA), Surgical Dressings – Policy Article (A54563), surgical dressings are covered when a “qualifying” wound is present. We must understand which wounds qualify. While there are different requirements for different dressing types, all wounds must meet certain criteria before the dressing type can even be considered. The LCA […]
Dispensing compression systems from my office is extremely rewarding. Patients enjoy being handed the product they need, rather than having to hunt for it in their community. Specifically, patients in need of compression therapy find that not all compression garments are right for them. Oftentimes, these patients enjoy the ease of application and adjustment that […]
As of January 1, 2020, the DMEMAC requirement for a “Detailed Written Order” when ordering surgical dressings has changed to the requirement for a “Standard Written Order”. The required elements of a Standard Written Order are almost the same as those of the Detailed Written Order. The required elements of the Standard Written Order include: […]
In last month’s post, we provided the information needed to access the current durable medical equipment (DME) and / or prosthetics (DMEPOS) fee schedule. When opening the file for the current fee schedule, the HCPCS codes are listed from top to bottom in column A. The reimbursement dollar value is listed for each state from […]
This should not be a guessing game, nor should it be a mystery. Knowing what your reimbursement should be for a service is an important tool in planning treatments and in checking your Explanation of Benefits (EOBs). This is the case with evaluation and management services, procedures, and durable medical equipment, including both surgical dressings […]
The short answer is… No. Medicare will not make separate payments for items dispensed during any inpatient stay in acute care hospitals, long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, or critical access hospitals. Medicare makes payments to these entities via different payment systems and all payments made through these systems are considered […]
The Centers for Medicare and Medicaid Services (CMS) require that DME suppliers maintain proof that any item dispensed was received by the beneficiary in the form of a Proof of Delivery document. This document must be maintained for at least seven years. This could be requested by DMEMACs, recovery auditors, supplemental medical review contractors, or […]
The Centers for Medicare and Medicaid Services (CMS) requires that DME suppliers maintain proof that any item dispensed was received by the beneficiary in the form of a Proof of Delivery document. This could be requested by DMEMACs, recovery auditors, supplemental medical review contractors, or Comprehensive Error Rate Testing (CERT) medical review contractors. In our […]