billing the dmercs and others for infusion pumps - ION Solutions

BILLING THE DMERCS ANDOTHERS FOR INFUSION PUMPSOr, Should I Bother?

DISCLAIMER This workshop and other material provided are designed toprovide accurate and authoritative information. The authors,presenters and sponsors have made every reasonable effort toensure the accuracy of the information provided in thisworkshop material. However, all appropriate sources should be verified for thecorrect ICD-9-CM Codes, ICD-10-CM Diagnosis Codes,CPT/HCPCS Codes and payer guidelines. The user isultimately responsible for correct coding and billing. The author and presenters are not liable and make noguarantee or warranty; either expressed or implied, that theinformation compiled or presented is error- free. All users needto verify information with the Fiscal Intermediary, Carriers,other third party payers, and the various directives andmemorandums issued by CMS, DOJ, OIG and associated stateand federal governmental agencies. The user assumes all risk and liability with the use and/ormisuse of this information.

BUZZWORDSDIF-DME Information FormDME – Durable MedicalEquipmentDMERC – Durable MedicalEquipment Regional CarrierABN – Advanced BeneficiaryNoticeNONC – Notice of Non-CoverageNEMB – Notice ofExclusions From MedicareBenefitsADMC – AdvanceDetermination of MedicareCoverageDMEPOS – DME,Prosthetics, Orthotics, andSuppliesSADMERC – StatisticalAnalysis DME RegionalCarrierLMRP – Local Medical ReviewPolicy␣See LCDPEN (Therapy) – Parenteral,Enteral NutritionCMN – Certificate of MedicalNecessityNSC – National SupplierClearinghouseLCD – Local CoverageDecision␣See NCDNCD – National CoverageDecisionMUE – Medically Unlikely Edit

DEFINITION OF DME Supplier: Can be a number of entities, but in yourcase, it means a a physician or other practitioner, oran entity other than a provider that furnishes healthcare services under Medicare. DME: DME is covered under Part B as a medical orother health service (§1861(s)(6) of the Social SecurityAct [the Act]) and is equipment that:Can withstand repeated use;Is primarily and customarily used to serve a medicalpurpose;Generally is not useful to a person in the absence of anillness or injury; andIs appropriate for use in the home.All above requirements of the definition must be metbefore an item can be considered to be durable medicalequipment

WHAT IS REIMBURSABLE DME? Payment may be made for the following: Items of DME that are reasonable and necessary Separate charges for repair, maintenance, anddelivery, if the DME is owned by the patient. Separate charges for disposable supplies, if they areessential for the effective use of medically necessaryDME. These must be customarily used with DME. DME must be used in patient’s residence otherthan a health care institution. A physician’s detailed order or prescription,and/or certificate of medical necessity (ifrequired) are necessary.

HOW IS DME PAID? DMERCs pay claims like any other Medicarecontractor based on submission of claims by thesupplier. DME has a fee schedule like physicians, labs, andother entities. It is updated annually and is availableon the CMS web site athttps://www.cms.gov/DMEPOSFeeSched/LSDMEPOSFEE/list.aspBy stateCeiling and Floor The DMEPOS fee schedule classifies fees byNewPurchase of used itemsPer month rental items

HOW IS DME CLASSIFIED? IN=Inexpensive/routinely purchased...DME; FS=Frequency Service...DME; CR=Capped Rental... DME; OX=Oxygen and Oxygen Equipment... OXY; OS=Ostomy, Tracheostomy and Urologicals..DME IN=Inexpensive/routinely purchased...DME; S/D= Surgical Dressings...S/D; Prosthetics and Orthotics...P/O; Supplies...DME; and TENS...DME,

PORTABLE PUMP RENTAL: CR 30.6 Capped Rental Items For these items of DME, contractors pay the feeschedule amounts on a monthly rental basis not toexceed a period of continuous use of 15 months. Inthe tenth month of rental, the beneficiary is given apurchase option (see §30.5.2). If the purchase optionis exercised, contractors continue to pay rental feesnot to exceed a period of continuous use of 13 monthsand ownership of the equipment passes to thebeneficiary. If the purchase option is not exercised,contractors continue to pay rental fees until the 15month cap is reached and ownership of theequipment remains with the supplier (see §30.5.4). Inthe case of electric wheelchairs only, the beneficiarymust be given a purchase option at the time theequipment is first provided (see §30.5.3).

PORTABLE PUMP: RENTAL PROVISIONS Capped Rental Fee Variation For the first three rental months, the capped rentalfee schedule is calculated so as to limit the monthlyrental to 10 percent of the average of allowedpurchase prices on assigned claims for newequipment during a base period, updated to accountfor inflation. For each of the remaining months, themonthly rental is limited to 7.5 percent of theaverage allowed purchase price. After paying therental fee schedule amount for 15 months, no furtherpayment may be made except for the 6-monthmaintenance and servicing fee (see §40.2).

CERTIFICATE OF MEDICAL NECESSITY For certain items or services billed to the DMERegional Carrier (DMERC), the supplier must receivea signed Certificate of Medical Necessity (CMN) fromthe treating physician.CMNs are not required for the same items when billed byHHAs to RHHIs. Instead, the items must be included inthe physician's signed orders on the home health plan ofcare. See the Medicare Program Integrity Manual, Chapter6.The FI will inform other providers (see §01 for definition pfprovider) of documentation requirements.Contractors may ask for supporting documentation beyonda CMN. Refer to the local DMERC Web site described in§10 for downloadable copies of CMN forms

OLD PUMP CMN—CMS FORM 851

BILLING FOR SUPPLIES AND DRUGS Suppliers and providers bill supplies that arenecessary for the effective use of DME, includingdrugs, with the appropriate HCPCS code identifyingthe supply. Suppliers and providers, other than HHAs, bill fordrugs that are necessary for the effective use ofimplanted DME (HCPCS codes E0751, E0753, E0782,and E0783) to the local carrier. The DMERCs must:accept NDC codes for all drugs billed in the NCPDPformat:accept NDC codes for oral anti-cancer drugs billed in ANSIX12N 837P, NCPDP and paper;accept HCPCS for all other drugs billed in ANSI X12N837P and paper;And return as unprocessable claims submitted with aninvalid NDC using Remittance Advice Remark Code N60.

SNF CONSOLIDATED BILLING The Social Security Act (§1861(n)) specifies that ahospital or a skilled nursing facility cannot be apatient’s home for purposes of the DME benefit. When DME is furnished for a patient in a SNF,the DME Carriers may not make separatepayment for DME, since DME is included in thepayment that the SNF receives for the thecovered stay itself.

WHO ARE THE DME MAC’S?WHY ARE THE SOOO DIFFERENT?

MAIN DME CONTRACTORS Durable Medical Medicare AdministrativeContractor (DME MAC) National Supplier Clearinghouse (NSC) Pricing, Analysis, and Coding (PDAC) Common Electronic Interchange (CEDI) Competitive Bid Implementation Contractor(CBIC)

DME MAC CONTRACTORS JURISDICTION ANHIC JURISDICTION BNational GovernmentServices (NGS) JURISDICTION CCIGNA GovernmentServices JURISDICTION DNoridian AdministrativeServices (NAS)

DME MAC Types of Claims DME Prosthetics Orthotics Supplies Process claims according to where the beneficiaryresides. Based on Social Security Administration address onfile.

NSC Supplier EnrollmentCMS 855-S application through PECOS or not.As of 3/25/2011, there is a $500 per applying supplier.Changes to enrollment must go through NSC Medicare DMEPOS Supplier Standards Verifies accreditation standardsExemption: Physicians and non-physician practitioners (asdefined in Section 1842(b)(18) of the Social Security Act) whenitems are furnished only to the physician or non-physicianpractitioner's own patients as part of his or her physicianservice. Verified Surety Bond requirementExemption: Physicians and non-physician practitioners (asdefined in Section 1842(b)(18) of the Social Security Act) whenitems are furnished only to the physician or non-physicianpractitioner's own patients as part of his or her physicianservice.

NSC Contact Infohttp://www.palmettogba.com/nsc 866-238-9652Medicare.NSC@palmettogba.com

PDAC Proper Use of HCPCS Assists CMS with DMEPOS fee schedules DMECS HCPCS information Modifiers Fee Schedules DMEPOS Product Classifications Contact Information https://www.dmepdac.com/ 877-735-1326

CEDI Single front-end electronic solution CEDI works closely with DME MAC software vendors Billing services Clearinghouses Trading Partners Free software Contact information http://www.ngscedi.com 866-311-9184 ngs.cedihelpdesk@wellpoint.com

GENERAL COVERAGEGUIDELINES

DME MAC COVERED DRUGS Epoetin alfa used in ESRD Other drugs used in home dialysis Oral anti-cancer drugs Oral anti-emetics used in chemotherapy Nebulizer drugs Immunosuppressive drugs used in transplant External infusion pump drugs

CAPPED RENTAL ITEMS(EXTERNAL INFUSION PUMPS) Paid on a monthly rental basis 13 month period Supplier transfers title to the beneficiary, if thebeneficiary wants the item Modifiers RR: Rental KH: Month 1 KI: Months 2-3 KJ: Months 4-13 EXAMPLE: Patient with a first month rental starting5/1/2011 would have a charge of: E0781-RR-KH charged 5/1/2011-6/1/2011

OTHER MODIFIERS JB: Administered subcutaneously Effective 1/1/2011 For all immune globulin and associated pump J1559, J1562. E0779 No modifier for other methods of administration ondrugs or pump—but there are rental modifiers aspreviously described. Not medically necessary GA: Waiver of liability on file, supplier expects denial GZ: No ABN obtained, item expected to deny as notreasonable or necessary GY: Item or service statutorily excluded, e.g.disposable pump EY: No order on file, denies, should have an ABN

PARTIAL MONTH BILLING (MEDICARE)??? Effective for dates of service on or after April 1, 2002, a newmodifier has been established to indicate billing of durablemedical equipment for a partial month of service: KR Rentalitem - billing for partial month.Suppliers who wish to exercise the option of billing Medicare for apartial month(s) of rental on DME should use the KR modifier afterthe pricing modifier.Although suppliers are entitled to bill and receive a full month’sreimbursement for rented DME provided to qualifying beneficiaries,suppliers now have the option of billing for a partial month of serviceand receiving reimbursement on a prorated basis by using the KRmodifier. A supplier has the option to bill a partial month for suppliesor for equipment if the supplier wants to avoid causing an overlapclaim.Suppliers who elect to bill for partial months should enter the date ofservice the rental period begins in the “From” field and the endingrental date of service in the “To” field of the HCFA-1500 (12-90) claimform for each partial month of billing. The modifier RR, indicatingrental, must also be appended to the claim line for the partial monthrental item(s). (Source: CIGNA Provider Bulletin 2002) Some payers (e.g. United) will pay ONLY a full month, evenwith this modifier.

DIF DOCUMENTATIONSection 1833(e) of the Social Security Act precludes payment to anyprovider of services unless "there has been furnished suchinformation as may be necessary in order to determine the amountsdue such provider". It is expected that the patient's medical recordswill reflect the need for the care provided. The patient's medicalrecords include the physician's office records, hospital records,nursing home records, home health agency records, records fromother healthcare professionals and test reports.This documentation must be available upon request.An order for eachitem billed must be signed and dated by the treating physician, kepton file by the supplier, and made available upon request.Items billed before a signed and dated order has been received by thesupplier must be submitted with an EY modifier added to eachaffected HCPCS code.A DME Information Form (DIF), which has been completed,signed, and dated by the supplier, must be kept on file by thesupplier and made available upon request. The DIF forExternal Infusion Pumps is CMS Form 10125. The initialclaim must include an electronic copy of the DIF.

DIF DOCUMENTATION If a patient begins using an infusion for one drugand subsequently the drug is changed or anotherdrug is added, a Revised DIF must be submittedfor use of the pump with the new or additionaldrug. In the case of an additional drug, all drugsfor which the pump is used should be included onthe Revised DIF. A supplier that is unrelated to your practice maynot complete the DIF form. It must be completedby a provider in your practice.

COVERAGE CONDITIONS FOR EXTERNALPUMPS (E0779, E0780, E0781, AND E0791)I. Administration of deferoxamine for treatmentof chronic iron overload;II.III.IV.Administration of chemo for primaryhepatocellular carcinoma or colorectal cancerwhere the patient refuses surgical excision ofthe tumor;Administration of morphine used in thetreatment of intractable cancer pain;Administration of continuous insulin in definedsituations (see your LCD for more information);AND

COVERAGE CONDITIONS FOR EXTERNALPUMPS (E0779, E0780, E0781, AND E0791)v. Administration of other drugs if EITHER of the followingcriteria are met:1 Criteria:a) Parenteral admin of the drug at home is reasonable and necessary;b) An infusion pump is necessary to safely administer the drug;c) The drug is infused for at least 8 hours because of improved clinicalefficacy;d) The treatment regimen is proven or generally accepted to havesignificant advantages over intermittent bolus administrationregiments or infusions lasting less than 8 hours.2 Criteria 2:a) First 2 criteria in above ANDb) The drug is administered by intermittent infusion (each episode ofinfusion lasting less than 8 hours) which does not require the patientto return to the physician’s office prior to the beginning of eachinfusionc) Systemic toxicity or adverse events of the drug is unavoidablewithout infusing it at a strictly controlled rate as indicated in thePDR or U.S. P. D. I.

COVERAGE CONDITIONS FOR EXTERNALPUMPS (E0779, E0780, E0781, AND E0791) Coverage for the administration of other drugs, basedon the criteria set in (1) or (2), using an externalinfusion pump is limited to the following situations: Administration of the anticancer chemotherapy drugscladribine, fluorouracil, cytarabine, bleomycin, floxuridine,doxorubicin (non-liposomal), vincristine or vinblastine bycontinuous infusion over at least 8 hours when the regimen isproven or generally accepted to have significant advantagesover intermittent administration regimens. Administration of narcotic analgesics (except meperidine) inplace of morphine to a patient with intractable pain caused bycancer that has not responded to an adequate oral/transdermaltherapeutic regimen and/or cannot tolerate oral/transdermalnarcotic analgesics.Administration of the following antifungal or antiviral drugs:acyclovir, foscarnet, amphotericin B, and ganciclovir. Administration of parenteral inotropic therapy, using the drugsdobutamine, milrinone and/or dopamine for patients withcongestive heart failure and depressed cardiac function if apatient meets all of specific criteria (See the LCD).

COVERAGE CONDITIONS FOR EXTERNALPUMPS (E0779, E0780, E0781, AND E0791)Coverage for the administration of other drugs, based on the criteria set in(1) or (2), using an external infusion pump is limited to the followingsituations:Administration of epoprostenol (J1325) or treprostinil (J3285) for patients withpulmonary hypertension if they meet specific disease criteria.Gallium nitrate (J1457) is covered for the treatment of symptomatic cancerrelatedhypercalcemia (ICD-9 275.42). In general, patients with serum calcium(corrected for albumin) less than 12 mg/dl would not be expected to besymptomatic.The recommended usage for gallium nitrate is daily for fiveconsecutive days. Use for more that 5 days will be denied as not reasonable andnecessary.More than one course of treatment for the same episode ofhypercalcemia will be denied as not reasonable and necessary.Ziconotide (J2278) is covered for the management of severe chronic pain inpatients for whom intrathecal (IT or epidural) therapy is warranted, and who areintolerant of or refractory to other treatment, such as systemic analgesics,adjunctive therapies, or IT morphine.Subcutaneous immune globulin (J1559, J1561, J1562) is covered only if BOTHOF THESE ARE MET:The subcutaneous immune globulin preparation is a pooled plasma derivative which isapproved for the treatment of primary immune deficiency disease; and The patient has a diagnosis of primary immune deficiency disease (ICD-9 codes 279.04,279.05, 279.06, 279.12, 279.2).Coverage of subcutaneous immune globulin applies only tothose products that are specifically labeled as subcutaneous administration products.Intravenous immune globulin products are not covered under this LCD.Coverage of subcutaneous products is only for drugs that are labeled subcutaneous, notfor IVIG. Only E0779 is covered under this situation.

COVERAGE CONDITIONS FOR EXTERNALPUMPS (E0779, E0780, E0781, AND E0791) External infusion pumps and related drugs and supplieswill be denied as not reasonable and necessary when thecriteria described by indication (I), (II), (III), (IV) or (V) arenot met. When an infusion pump is covered, the drug necessitatingthe use of the pump and necessary supplies are alsocovered. When a pump has been purchased by theMedicare program, other insurer, the patient, or the rentalcap has been reached, the drug necessitating the use of thepump and supplies are covered as long as the coveragecriteria for the pump are met. An external infusion pump and related drugs and supplieswill be denied as not reasonable and necessary in the homesetting for the treatment of thromb-oembolic disease and/orpulmonary embolism by heparin infusion. An infusion controller device (E1399) is not reasonable andnecessary.

COVERAGE CONDITIONS FOR EXTERNALPUMPS (E0779, E0780, E0781, AND E0791)An IV pole (E0776) is covered only when a stationary infusion pump (E0791) iscovered. It is considered not reasonable and necessary if it is billed with anambulatory infusion pump (E0779, E0780, E0781, E0784, or K0455).Supplies for the maintenance of a parenteral drug infusion catheter (A4221)are covered during the period of covered use of an infusion pump. They are alsocovered for the weeks in between covered infusion pump use, not to exceed 4weeks per episode.Supplies used with an external infusion pump, A4222 or K0552, are coveredduring the period of covered use of an infusion pump. Allowance is based on thenumber of cassettes or bags (A4222) prepared or syringes (K0552) used. Forintermittent infusions, no more than one cassette or bag is covered for eachdose of drug.For continuous infusion, the concentration of the drug and the size of thecassette, bag, or syringe should be maximized to result in the fewest cassettes,bags, or syringes in keeping with good pharmacologic and medical practice.Drugs and supplies that are dispensed but not used for completely unforeseencircumstances (e.g., emergency admission to hospital, drug toxicity, etc.) arecovered. Suppliers are expected to anticipate changing needs for drugs (e.g.,planned hospital admissions, drug level testing with possible dosage change,etc.) in their drug and supply preparation and delivery schedule.

COVERAGE CONDITIONS FOR EXTERNALPUMPS (E0779, E0780, E0781, AND E0791) Charges for drugs administered by a DMEinfusion pump may only be billed by the entitythat actually dispenses the drug to the Medicarebeneficiary and that entity must be permittedunder all applicable federal, state, and local lawsand regulations to dispense drugs. Only entitieslicensed in the state where they are physicallylocated may bill for infusion drugs. Drugs andrelated supplies and equipment billed by asupplier who does not meet these criteria will bedenied as not reasonable and necessary.

CODING FOR PUMP INFUSIONSHCPCS & CPT

HCPCS HCPCS Modifiers EY – No physician or other health care providerorder for this item or service GA – Waiver of liability statement issued asrequired by payer policy, individual case GY - Item or service statutorily excluded ordoes not meet the definition of any Medicarebenefit GZ – Item or service expected to be denied asnot reasonable and necessary JB - Administered subcutaneously KX - Requirements specified in the medicalpolicy have been met

HCPCS CODES E0781: AMBULATORY INFUSION PUMP,SINGLE OR MULTIPLE CHANNELS,ELECTRIC OR BATTERY OPERATED, WITHADMINISTRATIVE EQUIPMENT, WORN BYPATIENT A4221: SUPPLIES FOR MAINTENANCE OFDRUG INFUSION CATHETER, PER WEEK(LIST DRUG SEPARATELY) A4222: INFUSION SUPPLIES FOR EXTERNALDRUG INFUSION PUMP, PER CASSETTE ORBAG (LIST DRUGS SEPARATELY)

DMERC FEE SCHEDULECode Description Floor CeilingE0781 Monthly Rental $236.16 $277.83A4221 Weekly Supplies $20.19 $23.75A4222 Cassettes $41.67 $49.02These charges vary by the average charge for your state.

CPT CODES FOR OFFICEBILLING (TO MAC OR CARRIER)

96416—INITIATION OF PROLONGEDINFUSION Chemotherapy administration, intravenous infusiontechnique; initiation of prolonged chemotherapyinfusion (more than 8 hours), requiring use of aportable or implantable pumpNotice initiationDoes not say INITIAL---but that is not the way it isinterpreted.Can be billed with 96413 if administered through separatelines. Use -59 The physician or supervised assistant prepares andadministers a chemotherapeutic medication to combatmalignant neoplasms or microorganisms. This codeapplies to initiating an infusion that will take morethan eight hours and requires using an implantedpump or a portable pump to infuse the medicationslowly through catheter tubing placed in a vein.

WHAT IS INITIATION? Q: Chemotherapy coding for a patient that has a port-a-cathsubclavin and is sent home with a CADD pump to infuse over4 day period. Which CPT is correct: 96521 portable pump or96416 prolonged chemo infusion? A: If this is the first time the patient has been sent home withthe CADD pump, it would be appropriate to bill 96416 for theinitiation of prolonged chemotherapy infusion, requiring use ofa portable or implantable pump. If the patient has beenconnected to the CADD pump and is simply coming back to getan additional dose of the drug, the correct code to use is96521. If the chemotherapy is administered in anintermittent regimen and the patient is disconnectedfrom the pump, "each time a new course of therapy isinitiated it would be appropriate to report code 96416",according to a CPT Assistant article from theSeptember 2007 issue (Volume 17, Issue 9, pages 3-4). Source: ADVANCE for Coders, December, 2008

96521-REFILLING AND MAINTENANCE OF APORTABLE PUMP This code applies to maintaining or refillingportable pumps used for prolonged infusions. There are many unbundling edits on this codeincluding: 96413 96409 96365 96372 And, of course, 96416

RVUS AND FEES FROM 2011 FEESCHEDULE (GPCI= 1)Code Descrip NF RVUs Fee96416 Initiation 4.75 $161.3996521 Maintenance/Refill3.92 $133.19

A WORD ABOUT PRIVATE PAYERS(May Be Easier; May Be Harder)

IMPORTANT TO KNOW ABOUT BENEFITS… Does the patient have a benefit for DME or HomeHealth Care? Can be covered under either orboth for private payers… Does the payer need a referral, priorauthorization, and/or a CMN? Is the drug you are using covered under thepayers policy for home infusion? Do they have a preferred vendor and you are notit?

OTHER THINGS ABOUT PRIVATE PAYERS We checked Aetna, Anthem, Carefirst andCIGNA. Their guidelines look very similar toMedicare’s. Some differences we noticed: Bill to one place instead of two. Some allow supplies that Medicare does not: J1642 Needles and syringes S-codes for home infusions—hydration, etc. Check carefully with local instructions to see whatthey allow for—you may be missing revenue. Do not use Medicare fee schedules as your charge.

COMPLIANCE ISSUESHow You Can Get In Trouble

COMPLIANCE ISSUES Billing for items or services not provided (duh) Billing for services that should have been deniedby the DME MAC Billing for services not ordered or not signedorders Billing for items after they are no longermedically necessary Providing services that do not meet the DMEPOSstandards for quality and efficacy Delivery of items or services prior to receiving aphysician order or CMN

COMPLIANCE ISSUES Co-location of items with the referral source(consignment closets)---this may be a future problemfor folks who use DME vendors for pumps. THISRELATIONSHIP IS PROBLEMATIC. Receiving services from a pump vendor whenreferring patients, i.e. help with CMN, etc. Not notifying the NSC about a change in yourpractice such as address, etc. Billing for pumps while a patient is in SNF with thewrong anniversary date. Self-referral like imaging? Offering patients choices? Overlapping rentals: double billing for Medicare.

RESPONDING TO REQUESTS (CIGNA)Below are important TIPS for handling the requests: Read each request letter carefully. Note the due date given in the letter. (Denials will often occur if a response is not receivedwithin the stated timeframe.) Note where to send your response and be sure to respondto the correct office. (Delays andpossible denials will occur if you respond to the wrong office.) For prepayment claims, put the request letter on top of the documents you include in yourresponse. This helps ensure your documents are routed appropriately when received at thecontractor. (Prepayment means the claim has not completed processing yet.) Respond only one time. Don’t send your response multiple times.Do not combine responses. If the request letter asks for documentation on just one claim, onlyinclude documentation for that claim in your response. Send all documents for your response at one time. Don’t send part now and part later. Do not file duplicate claims. Keep track when you have received a request for additionaldocumentation on a prepayment claim. Do not file another claim for the same items justbecause you have not received a response as quickly as a claim where documentation was notrequested. Remember the contractors normally have longer time limits to review claims where additionaldocumentation was requested. Time limits will vary depending on the contractor, butgenerally the Centers for Medicare & Medicaid Services (CMS) allows at least 60 days forcontractors to complete the reviews once the documentation/records are received. Each of these contractors has a website, so information is easily accessible about each one.Visit the CGS website at: http://www. cignagovernmentservices.com/jc/index.html under theCustomer Service/Helpful Links section for links to the other contractors. Following is a link to a Medicare Claim Review Programs booklet from the Centers forMedicare & Medicaid Services (CMS) which may also provide helpful information for you:http://www.cms.hhs. gov/MLNProducts/downloads/MCRP_Booklet.pdf.

CONCLUSIONS & REFERENCES

CONCLUSIONS DME billing is complex, but think about it step-bystepeach time the patient is hooked up:Do I need a DIF for this patient? Can’t place the pumpwithout this and an order.Where is the patient in therapy? What month is it?What is their anniversary date? What have theyaccumulated in billable supplies? What should be billed?Is it time to start talking about purchase? Don’t forget to bill Part B! If you are not billing now, think about this:ComplianceRevenue source and drugs get paid more, even forMedicare!If you are dispensing, you should be doing this…

RESOURCES Medicare DME CENTRAL INFOhttps://www.cms.gov/center/dme.asp DMERC POLICY FOR INFUSION PUMPShttps://www.noridianmedicare.com/dme/coverage/docs/lcds/current_lcds/external_infusion_pumps.htm NORIDIAN WEB SITE (GREAT INFO)https://www.cms.gov/center/dme.asp CMS WHITE PAPER ON INFUSION PUMPShttps://www.noridianmedicare.com/dme/coverage/docs/lcds/current_articles/external_infusion_pumps.htm AETNA POLICY ON INFUSION PUMPShttp://www.aetna.com/cpb/medical/data/100_199/0161.html

DME RESOURCES Durable Medical Equipment AdditionalMaterials␣ 42 CFR § 424.57 CfPs (Conditions for Payment) – DMEPOS CMS Publication 100-03 – MCPM – Chapter 20 PM B-03-020 – Jurisdictional Listing PM AB-03-100 – Quarterly Update DME Modifiers for ABNs PM AB-02-114 – DMEPOS Refunds – ABNs PM AB-02-168 – DMEPOS Refunds – ABNsCorrections PM B-03-003 – DMEPOS Refund Requirements PM B-01-64 – DMERC – ABNs for Upgrades PM B-01-68 – DME Upgrades