ReaDME: The latest in DME news February 2019


DME Today

The latest in DME news, from regulations and guidelines to payer and patient trends.

Billing Dually Eligible Beneficiaries in the QMB Program
CMS released the yearly reminder on the restriction to bill Beneficiaries who are dually enrolled in Medicare and state Medicaid programs, or Qualified Medicare Beneficiaries (QMB). It is prohibited to bill the beneficiary for any cost sharing liability from Medicare when the patient is enrolled in the QMB program. Each State Medicaid program has different guidelines when it comes to billing the cost sharing amount to the state Medicaid program, so be sure to check with your state’s program.

Healthcare Updates

Upcoming events and news to keep you ahead of the curve.

CMS released a new app for Medicare Beneficiaries called “What’s Covered” that allows users to search for covered services and has contact information available to them in case their question cannot be answered from the app. The app is available free for download on Android and Apple devices.

Best Practices

Do’s and don’t’s developed to maximize returns and minimize denials.

During the temporary gap period, non-participating providers are permitted to submit non-assigned claims to Medicare on behalf of a beneficiary. In order to protect the supplier from liability, it is recommended to have the patient sign an ABN at the time of service, and for a rental, before each rental claim submitted. Please be sure to follow the instructions for how to submit an ABN for a non-assigned claim.

  • Ensure you are using the correct ABN form. The form should have a date at the bottom “Exp. 03/2020”. If you are using the old formatted form, the ABN is not valid.
  • Cross out the last sentence in Section G, under option 1 with a single line. “If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles.”
  • Add the following statement to Section H. “This supplier doesn’t accept payment from Medicare for the item(s) listed in the table above. If I checked Option 1 above, I am responsible for paying the supplier’s charge for the item(s) directly to the supplier. If Medicare does pay, Medicare will pay me the Medicare-approved amount for the item(s), and this payment to me may be less than the supplier’s charge.”
  • Fill out the remainder of the ABN as it would normally be filled.