ReaDME: the latest in DME news May 2019

United Health Care has begun to deny CPAP/BIPAP supplies claiming they are bundled in the reimbursement for the machine. Most suppliers affected have started to see the denials starting in April 2019. Most denials appear to be remark code 234– Payment included for another service–. This is a somewhat abrupt change and does not follow the reimbursement methodology of Medicare, which United Health Care typically follows.

Round 2021 Competitive Bidding introduces the Lead Item Pricing bid for the first time. Supplier should take note of the rules for bidding with lead items. The bid for the lead item in each bid category will determine the reimbursement amount for all the items that fall within that category. There are bid ceilings for each lead item which are available on the CBIC website. www.dmecompetitivebid.com. CBIC also released a lead item pricing calculator to assist providers in realizing the impact of the lead item bidding on the other products in the bid category.

Are you using a third-party vendor to ship supplies to your patients? If so, make sure you are keeping an accurate proof of delivery on file for each shipment. All shipments must be able to tie each item dispensed from order to delivery. National carriers such as UPS, Fed-Ex and the United States Postal Service recycle their tracking numbers every 60-180 days. Be sure to keep a copy of the detail tracking before the tracking number is recycled.