Medicare question

Medicare question

Randall McFarland, CPO

Hello List members-
   For your perusal, I am posting a question I sent to Kathy Dodson, followed
by her answer:
QUESTION:
Hi Kathy,
  I performed the fitting of an LS corset to a patient and billed the
hospital and now the patients is wanting me to come to his house to make
adjustments.
   Am I prohibited from charging the patient for an out of office visit?
(As opposed to the normal included followup care that is included)
   If I am prohibited from the out of office visit charge, is there a
limit to the distance that I am expected to travel to give this included
care?
    How long after the hospital fitting must this included care continue?
(I understand that if there's a change in the patient's condition I can
charge for additional services.)
  Does it matter if the original service was out of office or in office?
  What if the patient decides they don't want to come in for followup and
insist that I do a home visit?
   Do you have a FAQ page to address the issues you've already answered?

Thanks, Kathy


Randy McFarland, CPO

PS With your permission, I'll post your answer to the list server.

ANSWER:
Under Medicare, when you deliver a device, you are prohibited from charging
separately for any type of visit, since this program doesn’t recognize a
separate professional fee for suppliers. This also means that you could not
charge the patient for the visit, since Medicare considers that you have
already been paid for it in the payment for the device.. However, if you see
a patient but do not end up providing a device to that patient, then that
visit should simply be considered as a non-covered service (since it is not
included in the payment for a device) and you should be able to bill the
patient. Medicare has never made any pronouncement on this situation, but
that is AOPA’s interpretation. I don’t know how often this happens, but I
understand that it is not too common.
 
Medicare has also never addressed any distance limits since they don’t
recognize any reimbursement for this separate service. Regarding time
frames, the lower limb medical policy states that adjustments that are not
caused by a change in condition or functional abilities must be made for 90
days from the date of service at no charge. The other medical policies (e.g.
AFO/TLSO, spinals, shoes) don’t make reference to a time frame, but I would
recommend applying the same 90 day criteria. In addition, if an item is
still under warranty, you cannot bill Medicare for repairs or replacements.
 
The location of the original service does not affect charging for
adjustments/repairs. If the patient refuses to come in, that unfortunately
still does not make it a separately compensable visit.
 
At this point, we don’t have a FAQ section on our web site, but we are
redesigning it and hope to have something like this in the future. Hope this
information is helpful. If you need anything else, let me know.
Kathy
PS. Fine to post this