Thanks to all who responded so promptly. The consensus seems to be that
medical necessity dictates that two liners are appropriate for a 12 month period.
See original query, and the responses listed below….
I’ve had a patient recently request 6 liners prior to going on an extended
trip to Europe for study. She currently is covered by Medicare primary, and
Medicaid secondary for prosthetic supplies.
It is our practice to supply two liners per year/device or replace as
necessary, and never had a request to “stock up” until now.
Does anyone know definitively how many liners are allowed per patient, per
year by our friends at Medicare?
I appreciate your responses and will post.
Joel Kempfer CP FAAOP
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I think you are asking for trouble trying to get approval for more than
two liners per year. You will have to bill medicare with a date of service for
a specific quantity. If you bill for 6 you are most probably going to be
denied and not get paid for any. You may also be red-flagging yourself for
closer scrutiny or audit with this escessive quantity. I suggest you ask your
patient to ask her physician to write a prescription for replacement while she
is abroad studying and then ship her two liners with a proof of delivery
form and have her return that to you when she gets the items and then bill
medicare for only those two. Don’t make a problem for yourself just because your
patient wants to circumvent accepted billing and procurement practice. Hope
this helps.
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I would suggest that your patient allow you to mail the liners…maybe one
liner each month for 6 months. That way your service dates will be different.
As an accessory to the original prescription you technically don’t need an
order…but I would fashion one explaining the nature of the “medical
necessity” for the items and have the doc sign off. As a safeguard have the patient
sign the form that removes your responsibility in the event of a denial and
explain that if Medicare denies, the patient will be responsible. In my
experience the liners are not likely to be denied because they are being billed
independent of the base code.
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They will pay for 2. Self pay for the rest.
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This sounds to me that the service is being provided or requested solely as
a “convenience” for this patient, so I would be skeptical that you would be
able to convince Medicare of the “medicl necessity.” An ABN sounds like a
wise precaution to take. Good luck.
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Zip. Nada. Zero. None. Nothing, no way, not at all.
