Medicare Rules Contributing to a Fraud Free DME Billing!

documentation, this prior authorization will oblige companies to validate relevant coverage, coding, and clinical documentation concerns before a beneficiary receive a product and before a Medicare benefit claim is submitted. Modifying the process in this way will prevent beneficiaries from being forced to pay for items that aren’t covered by Medicare.”

CMS also created a master list containing 135 items that are subjected to prior authorization before the equipment is provided to the beneficiary. It should have an average fee of USD 1000 or greater or a rental fee of USD 100 or greater. Also, CMS highlighted a 3-year prior authorization demonstration project for power mobility devices (PMD – wheelchairs, scooters, etc.) to reduce expenditures.

• A face-to-face examination is required of the patient by the physician to determine the usage of PMD as a medical necessity.

• This prescription must be issued to the DME supplier within 45 days of the examination.