Saturday, May 21, 2022

Clarification for billing DMEPOS in SNF

Jeremy Sprouse

After reading an article in the Oct. 2016 O&P Almanac, I thought I was
missing the boat when billing for items delivered in a SNF.

The article states “After 100 days of Medicare Part A SNF coverage within a
benefit period, Medicare Part A no longer covers the SNF stay. If the
patient remains in the SNF, he or she must pay for room, board and nursing
expenses through personal funds or other insurance. Medicare Part B will
cover any orthotic and prosthetic care that the patient needs. When this is
the case, you may submit your claim directly to the DME MAC for
consideration.

Please be advised this article is incorrect. While partially true, the SNF
must be considered their home, and the SNF must not provide primary skilled
nursing, or rehab. Please read the following CMS article for clarification.

https://oig.hhs.gov/oei/reports/oei-06-07-00100.pdf

I bring this to attention since the OIG is planning on auditing claims for
patients who received DMEPOS while in a SNF.

http://www.oandp.com/articles/NEWS_2016-11-11_03.asp

Please let me know if I am missing something here, I believe the O&P almanac
article to be incorrect, and may cause a financial burden to companies
providing DMEPOS while the patient is in a SNF.

Jeremy Sprouse CPO, BOCOP

Advanced Biomechanical Solutions

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