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 […]
The Centers for Medicare and Medicaid Services (CMS) has announced waivers and loosened some provider restrictions since the public health emergency was declared. There have been new announcements every day. A concern among providers who dispense surgical dressings is the need to document, on a monthly basis, clinical information which demonstrates the reasonable and necessary […]
When dispensing surgical dressings, the dressing size should be selected based on the size of the ulcer being treated. From a clinical standpoint, the dressing should cover the entire ulcer. From a compliance and payment standpoint, it is not appropriate to use a large dressing size when a smaller size was available that could have […]
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: […]
When dispensing surgical dressings, it is important that the dressing size is selected appropriately based on the size of the ulcer being treated. The dressing should be large enough to cover the entire ulcer. However, you cannot expect reimbursement for a dressing when a smaller size is available that could have covered the same ulcer.
AMERX Health Care provides you with extensive resources that include everything you need for perfect documentation to ensure compliance when dispensing surgical dressings. The majority of this guidance comes from the DMEMAC Surgical Dressings LCD and the DMEMAC Surgical Dressing Policy Article. On December 3, 2019, the DMEMACs released some additional guidance in the form […]
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 […]