Documentation Requirements For DME In The Medical Office

Date	Oct 18, 2018
Time	12:00 PM EDT
Cost	$213.00
Online

Durable Medical Equipment (DME) is used to treat conditions and injuries that patients are recovering from.  One way a patient can receive a DME is when the office purchases the DME from a manufacturer or distributor and then dispenses these items to patients.  CMS and Medicare require that the patients meet certain requirements for them to reimburse a provider for these items, and that the medical necessity for these items for a particular patient are met based on policies that have been created.  CMS and Medicare also require that the provider documents specific information in the medical record to meet their requirements, and also has proof the patient actually received the item and understands how to use the DME.  In circumstances that Medicare may not pay for an item, the patient has to be made aware of this when the item is given to them, and they have to sign an Advanced Beneficiary Notice (ABN) stating they understand their insurance may not cover the item, and they will be responsible.  CMS and Medicare have found that many offices are not obtaining the required documentation when dispensing DME.  This can result in CMS and Medicare asking for  the monies they have paid to the provider, sometimes with penalties, which becomes a financial loss for the provider who has paid for these items.  Understanding what is required by the provider is essential in the dispensing of DME to patients be a revenue stream for offices and not a loss.  

Areas covered in the session:

• Stark Law
• Policy Article Changes  
• Article Changes November 2017
• CMS Program Integrity Manual
• DME Documentation requirements
• Ordering/referring physician must be a Medicare-enrolled physician
• Orders
• Dispensing Orders
• Detailed Written Orders
• Medical Necessity Statement
• Medical Records
• 3 Types of Delivery  
• Proof of Delivery
• ABN
• Modifiers KX
• Potential to bill both KX and GA/GZ modifier
• Modifiers KT-KY
• Modifiers used with DME that is part of the Competitive Bidding Program 
• Coverage Modifiers
• CMS Reference
• Terminology DME
• DMEPOS= Durable Medical Equipment Prosthetics and Orthotics Services
• CMS Definition Of Brace
• Repair/Replace Orthotic
• Orthotic Training
• DMEPDAC

Who will benefit?
Coders, billers, physicians, Physician Assistants, Nurse Practitioners, auditors.