When a patient enters into a Skilled Nursing Facility (SNF), generally DME items are not separately payable, but there are a few exceptions (mostly part B physician services). However, beyond the first 100 days of the Part A stay, certain Part B covered services are separately billable by a DME supplier. Those items are orthotic and prosthetic devices, enteral nutrition, ostomy supplies, urological supplies, tracheostomy supplies and surgical dressings.
If you are billing for a recurring rental item that is not separately billable (and the patient is admitted to a SNF), upon discharge you can update your anniversary date to coincide with the discharge (if discovered within 30 days of your original bill date).
If you are billing for a recurring rental item that is not separately billable (and the patient is admitted to a SNF), upon discharge you can update your anniversary date to coincide with the discharge (if discovered within 30 days of your original bill date).
If this is discovered after subsequent dates of service have generated, then the best protocol is to write off the denied claim and extend your rental in your billing system to permit the remaining months to bill at the end of the cycle for full payment. Anytime that you bill for a break-in-service be sure to include a narrative with future claims to extend the rental for remaining months due to break-in-service. This protocol will proactively avoid denials when billing dates of service past what Medicare expects to be the cap.
A unique tool was added by the Jurisdiction A DME MAC (NHIC) to aid suppliers in identifying whether a DME HCPCS is separately billable when a patient is undergoing care from a Home Health Agency, Hospice or is in a Skilled Nursing Facility. The tool allows the supplier to enter a HCPCS for search and returns results on whether that code is (or is not) separately billable during the various episodes of care. Although this useful tool is located on the NHIC website, it can be used by any supplier regardless of Jurisdiction.
A unique tool was added by the Jurisdiction A DME MAC (NHIC) to aid suppliers in identifying whether a DME HCPCS is separately billable when a patient is undergoing care from a Home Health Agency, Hospice or is in a Skilled Nursing Facility. The tool allows the supplier to enter a HCPCS for search and returns results on whether that code is (or is not) separately billable during the various episodes of care. Although this useful tool is located on the NHIC website, it can be used by any supplier regardless of Jurisdiction.
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