billing the dmercs and others for infusion pumps - ION Solutions

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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.Â 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.
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 10 and 11: PORTABLE PUMP: RENTAL PROVISIONS Ca
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 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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