Medicare Reimbursement Calculation SQ

How Much Are You Getting Paid For That? Part II

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 […]

DMEPOS-Fee-Schedule_SQ

How Much Are You Getting Paid For That? Part I

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 […]

New_US_Medicare_Card_Sample_2018_SQ

Time to Start Using Medicare Beneficiary Identifiers

The Centers for Medicare and Medicaid Services (CMS) have removed social security-based claim numbers from Medicare cards and are instead using Medicare Beneficiary Identifiers (MBIs) for Medicare transactions.  All Medicare beneficiaries have received their MBIs, and it is important to collect that information. Physicians must start using the MBI instead of the social security number […]

Can You Dispense Surgical Dressings/Wound Care Supplies to an Inpatient?

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 […]

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Get Ready! Additions to Pressure Ulcer Coding Coming Soon

Surgical dressings can be used for all types of qualifying ulcers.  This includes arterial ulcers, venous ulcers, diabetic foot ulcers, and pressure ulcers.  It is important to use the correct diagnosis codes for each of these ulcer types.  Diabetic foot ulcer codes should start with L97-.  Stasis ulcer codes begin with I83-. L89- codes are […]

Dispensing Primary and Secondary Dressings With Different Change Frequencies

When dispensing surgical dressings, it is important to differentiate between primary and secondary dressings and to use them in conjunction when indicated. PRIMARY DRESSINGS Primary dressings are therapeutic or protective and can be applied directly to ulcers. SECONDARY DRESSINGS Secondary dressings are needed to secure and/or aid in the function of a primary dressing. A […]

Proof of Delivery Forms

Proof of Delivery: Part 4

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 […]

Proof of Delivery Forms

Proof of Delivery: Part 3

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 […]

Proof of Delivery Forms

Proof of Delivery: Part 2

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. It may be requested by DMEMACs, recovery auditors, supplemental medical review contractors, or Comprehensive Error Rate Testing (CERT) medical review contractors. In last […]

Proof of Delivery Forms

Proof of Delivery: Part 1

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 proof may be needed to substantiate payment. It may be requested by DMEMACs, recovery auditors, supplemental medical review contractors, or Comprehensive Error […]