billing the dmercs and others for infusion pumps - ION Solutions

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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
Page 1: BILLING THE DMERCS ANDOTHERS FOR IN
Page 4 and 5: BUZZWORDSDIF-DME Information FormDM
Page 6 and 7: WHAT IS REIMBURSABLE DME? Payment m
Page 8 and 9: HOW IS DME CLASSIFIED? IN=Inexpensi
Page 12 and 13: OLD PUMP CMN—CMS FORM 851
Page 15 and 16: SNF CONSOLIDATED BILLING The Social
Page 17 and 18: MAIN DME CONTRACTORS Durable Medica
Page 19 and 20: DME MAC Types of Claims DME Prosthe
Page 21 and 22: NSC Contact Infohttp://www.palmetto
Page 23 and 24: CEDI Single front-end electronic so
Page 25 and 26: DME MAC COVERED DRUGS Epoetin alfa
Page 27 and 28: OTHER MODIFIERS JB: Administered su
Page 32 and 33: DIF DOCUMENTATIONSection 1833(e) of
Page 34 and 35: COVERAGE CONDITIONS FOR EXTERNALPUM
Page 42 and 43: HCPCS HCPCS Modifiers EY - No physi
Page 44 and 45: DMERC FEE SCHEDULECode Description
Page 46 and 47: 96416—INITIATION OF PROLONGEDINFU
Page 48 and 49: 96521-REFILLING AND MAINTENANCE OF
Page 50 and 51: A WORD ABOUT PRIVATE PAYERS(May Be
Page 52 and 53: OTHER THINGS ABOUT PRIVATE PAYERS W
Page 54 and 55: COMPLIANCE ISSUES Billing for items
Page 56 and 57: RESPONDING TO REQUESTS (CIGNA)Below
Page 58 and 59: CONCLUSIONS DME billing is complex,
Page 60:
DME RESOURCES Durable Medical Equip
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