billing the dmercs and others for infusion pumps - ION Solutions

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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
Page 1: BILLING THE DMERCS ANDOTHERS FOR IN
Page 4 and 5: BUZZWORDSDIF-DME Information FormDM
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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billing the dmercs and others for infusion pumps - ION Solutions

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