billing the dmercs and others for infusion pumps - ION Solutions

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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
Page 1: BILLING THE DMERCS ANDOTHERS FOR IN
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 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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