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Here are Miriam Lieber’s answers to frequently asked home health care questions.

QUESTIONS

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Q. Do I have to issue an ABN (Advance Beneficiary Notice) if I am providing      a customer with excessive quantities of supplies?

Q. If a Medicare patient (who has a written order from a physician) wants to      buy a manual wheelchair rather than rent one, am I permitted to do so?

Q. If I am renting an item to a Medicare beneficiary and the first month’s      claim is denied, can I issue an ABN before the second month is billed?

Q. If an item is irreparably damaged or lost, do I have to wait 5 years to      issue a new one since Medicare states that reasonable useful life = 5      years?

Q. For diabetic claims, which items require span dates?

Q. Am I allowed to dispense more than one month’s supply for diabetic      supplies?

Q. When I bill for two items that are required for both the right and left, may      I bill it on one line or must I issue two line items?

Q. On CPAPs, to determine continued coverage beyond the first 3 months,      must I contact both the physician and the patient?

Q. Do support surfaces require a CMN?

Q. Does a CPAP require a CMN?

QUESTIONS AND ANSWERS

Do I have to issue an ABN (Advance Beneficiary Notice) if I am providing a customer with excessive quantities of supplies?
Yes, if you supply the patient with excessive quantities, you would have to issue an ABN to recoup the difference between the amount allowed by Medicare and the amount desired by the patient.

If a Medicare patient (who has a written order from a physician) wants to buy a manual wheelchair rather than rent one, am I permitted to do so?
According to Sabrina of the Benefit Integrity Unit of Medicare’s Region D DMERC, Cigna Medicare, if a patient wants to buy a wheelchair, issue an ABN telling the patient that Medicare won’t pay for the purchase of the wheelchair and thus the patient will not get reimbursed.

If I am renting an item to a Medicare beneficiary and the first month’s claim is denied, can I issue an ABN before the second month is billed?
Yes, you may issue an ABN in second or subsequent month.

If an item is irreparably damaged or lost, do I have to wait 5 years to issue a new one since Medicare states that reasonable useful life = 5 years?
No, if the item is irreparably damaged or lost, show Medicare evidence and they will pay for a new one. A new order is not required.

For diabetic claims, which items require span dates?
Blood glucose test reagent strips (A4253)
Platforms (A4255)
Glucose control solution (A4256)
Lancets (A4259)

Am I allowed to dispense more than one month’s supply for diabetic supplies?
Yes, you may dispense up to a 3 month supply. Make sure to remember the span dates.

When I bill for two items that are required for both the right and left, may I bill it on one line or must I issue two line items?
You may bill it as one line item but append two modifiers, LTRT with two units.

On CPAPs, to determine continued coverage beyond the first 3 months, must I contact both the physician and the patient?
No, you may contact either the treating physician or the patient. Make sure to document this in writing.

Do support surfaces require a CMN?
Only group 3 support surfaces require a CMN. A statement from the ordering physician is required for groups 1 and 2 support surface. Your DMERC manual provides a sample form for group 1 and group 2 respectively.

Does a CPAP require a CMN?
No, CMNs are no longer required for CPAPs.