July 21, 2020 - BY Admin

How to bill DME claims to Medicare

How to Bill DME Claims to Medicare

Do you know how to bill the appropriate Durable Medical Equipment (DME) claims to Medicare as a supplier? To bill the appropriate Medicare claims, you need the information from the Medicare procedures for Durable Medical Equipment (DME) from DME medical billing services. As the best billing services for DME, we will be sharing with you the Medical procedures for consideration to bill DME Medicare claims;
In the Medicare Claims Processing Manual, Chapter 20, Section 50, there is a policy regarding Medicare’s customary payment policy for replacement of DMEPOS “Medicare will pay for the equipment replacement which a beneficiary owns or is purchasing is oxygen equipment, or is a capped rental item when the equipment/item is lost, destroyed, irreparably damaged, or otherwise rendered unusable due to an emergency situation declared by the President but they will not pay for the replacement of rented equipment”.
Medicare will pay for Medicare-covered service by DME medical billing service such as ambulance service to transport the beneficiary to another location. Medicare does not have a benefit category that allows for separate coverage of a surgical mask to prevent the spread of infectious diseases if prescribed by a physician, and will not cover the cost of a generator used to power DME for medical needs.
When beneficiaries have been displaced with no contact from a DME medical billing service, they may contact 1-800-Medicare on a telephone for information regarding suppliers serving their current location, or they can go to the Medicare website on the internet to obtain directory listing suppliers by geography, proximity, and name to get access to DME, and DMEPOS.

Medicare will not provide additional payment to the fee schedule amount that the supplier is already receiving for any patient even if payments are higher than the usual monthly oxygen payments. Medicare will pay for portable oxygen only if the patient has medical needs.

However, Medicare is providing some relief at the time of the natural disaster, Face to face document can be ignored at the time of emergency, but other medical necessity documents are must to submit the claim to Medicare.
Where oxygen equipment needs to be replaced when lost as a result of the disaster, to a claim replacement for the lost equipment in disaster situations, the supplier must follow the normal process for submitting, then Medicare begins the 36 months payment and proper documentation describing the need for replacement for the lost equipment.

Medicare’s payment rules regarding payment for oxygen services in an emergency, especially about changes in delivery modalities from stationary to portable patterns made necessary by an emergency, is that the Medicare statute has mandated a modality-neutral payment method for oxygen since 1989, suppliers of the best billing service for DME cannot receive increased or decreased payments for a type of modality furnished except for the additional add-on payment for portable equipment.

If a beneficiary was already receiving portable oxygen equipment, Medicare monthly basis payment includes payment for all of the different oxygen equipment modalities and oxygen dispensing modalities; such as oxygen concentrator, liquid and gaseous cylinders, and also the add-on payment ( add-on payment includes an additional payment when portable equipment is used and necessary).

In the events of limited utilities/ emergency such as a disaster, flash flooding, etc. where beneficiaries needed to leave their homes quickly to a new location when there is a secondary supplier for any hospital equipment, Medicare does not authorize a duplicate payment for the same month. The secondary supplier of oxygen equipment should seek reimbursement from the initial supplier of DME medical billing services that received the Medicare monthly basis payment and the secondary the supplier can only bill for Medicare monthly basis payment the next continuous months after the month the initial supplier has received payment is over.

In the events of natural disaster situations, if replacement accessories were lost, destroyed, irreparably damaged, or rendered unusable by disaster situations, the replacement accessories can be furnished by a secondary supplier if the initial Suppliers cannot provide replacement accessories to the beneficiary. Medicare will pay for the replacement accessories in the events of disaster situations.

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