DME Billing Services

DME Supplies: CMS Flexibilities to Fight COVID-19

From the beginning of the outbreak, the government has issued an uncommon range of temporary regulatory exemption as well as new rules and regulations in order to solidify the American healthcare system with the utmost flexibility to fight with the Novel Coronavirus (COVID-19) pandemic. These temporary changes in the guidelines will apply all over the United States healthcare system during the emergency period of the pandemic. Major goals of these actions are as follows:

  • To make sure health systems and local hospitals have the capability to manage COVID-19 patients’ upsurge via temporary expansion site, which is known as CMS Hospital Without Walls
  • To make the hiring process simple, which means there will be no barriers for nurses, physicians, and other clinicians to be hired form different states or communities. This leads to the expansion of healthcare workforce at a faster pace
  • Penetration of telehealth in Medicare
  • Increase in-place testing to permit for several testing in a community-based setting or at home
  • Minimalistic paperwork; bring Patients Over Paperwork in order to offer temporary relief from different paperwork, therefore health care facilities, providers, Medicare Advantage and Part D plans, and States can aim at offering required care to Medicare and Medicaid beneficiaries impressed by COVID-19

“Stark Law” Waivers

Stark Law is also known as the physician self-referral law forbids a physician from making referrals for specific healthcare services payable by Medicare if the physician has a financial relationship with an individual performing service. This means a physician can’t refer a patient to any individual with which she or he possesses a financial relationship.

On 30th March 2020, CMS announced blanket waivers of particular provisions of the Stark Law regulations, which are applicable to financial relationships and referrals that are linked to the novel coronavirus emergency. As part of the waivers, CMS will allow particular referrals and the submission of related claims that would otherwise breach the Stark Law.

These flexibilities include:

  • Health care providers and hospitals can pay below or above fair market value for the personal services of a physician, and parties may pay below fair market value to purchase services or items or to rent equipment
  • In order to the continuity of health care operations, health care providers can financially help each other
  • Hospitals can offer advantages to their medical staffs, like laundry service to launder dirty personal clothing, multiple daily meals, or child care services while the physicians are at the hospital and engaging in events that advantage its patients and the hospital
  • Health care providers can provide particular services or items, which serve COVID-19 purposes, even when the provision of the services or items would extend the annual non-monetary compensation cap.
  • During the emergency private hospitals can temporarily expand their number of licensed beds, procedure rooms, and operating rooms, otherwise, such kinds of expansion are restricted under Stark Law
  • Some of the limitations concerning when a group practice can perform medically required designated health services (DHS) in the home of patients are relaxed.
  • Group practices can perform medically required CT scans, clinical laboratory services, or MRIs, from locations such as mobile vans in parking lots which is taken on rent by group practices

As far as Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DEMPOS) are concerned, when it is destroyed, lost, rendered unusable, or irreparably damaged, DME Medicare Administrative Contractors have the flexibility to waive replacements necessities under Medicare in such a way that medical necessity documentation, an order of a new physician, and face-to-face requirement are not essential.

Suppliers have to incorporate a description on the claim describing the reason for equipment replacement. Moreover, they are reminded to keep documentation representing that the DMEPOS was destroyed, lost, or irreparably damaged, or unavailable as a result of the pandemic.

Prior Authorization in DMEPOS

CMS is temporally stopping the national Medicare Prior Authorization program for particular DMEPOS items.

DMEPOS Accreditation

CMS is not needing accreditation for new DMEPOS suppliers and is expanding any expiring supplier accreditation for the timeline of 90-days.

The rise in the DMEPOS payment

As needed by section 3712(b) of the CARES Act, CMS will offer greater payments for specific.

DMEPOS items and services performed in non-rural, non-competitive bidding areas in the parts of COVID-19 affected the United States on or after 6th March 2020.

Signature Necessities

CMS is waiving proof of delivery and signature necessities for Durable Medical Equipment and Part B drugs when a signature can’t be attained owing to the failure to gather signatures. It is necessary for suppliers to document the proper date of delivery and impossibility in collecting signature due to the COVID -19 crisis in the medical records.

Signature on Orders

Apart from Power Mobility Devices (PMDs), other DMEPOS items can be ordered verbally. A signature is needed before submitting claims for payment; however, the order can be signed electronically. PMDs needed to be written as well as signed order before delivery.

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