#18

#18

Jake Wood, CP

These are the responses I have received to date. At the end someone gave me
the link to the Medicare site with Medicare's official position. Thanks to
everyone for responding:


I do not recall. I know you can receive payment for partial completion
also..............
..................

He can bill for items he has completed. He will need to use the date of
service as the date the patient passed away. His charting should reflect that the
patient has passed away, as well.

We have done this several times successfully in the past.
...........

 Medicare will only allow you to bill for any product that cannot be reused.
Those are the only things that can be billed under these circumstances.

............................
You would bill using the decease date and document with photos and the
amount of progess that cannot be salvage for parts.

..........................
If you walked the patient, had a dynamic alignment, but the patient died, I
would probably bill for a preparatory. I believe you could justify that ( This
one may not be my first choice, J.R.W., but thank you for the suggestion)

.............................

    Medicare provides a modifier that can accommodate such situations - it is
the 52 modifier. It is used when the service provided is less than that
normally provided. Ideally, you would have the spouse (or appropriate legal
guardian/relative) sign a receipt that indicates the prosthetic fitting services
you have provided to date and give them a copy of the 1500 form with the 52
modifier explaining that it reflects a reduced charge. Depending on the
circumstances, you would use the 52 modifier on the base code. If you have not
provided components, there would be no charge for them. If you used components or
supplies that touch the skin, there is no 52 modifier applied to those. If you
want to talk about this feel free to call.

...................

We have done this many times. You are permitted to bill for items completed
that cannot be returned or reused. You cannot bill socks, cuff straps,
liners, feet, etc. You can bill for the socket, check socket, etc. We usually
leave off the frills such as ischial containment and total contact and have
never had any problems receiving payment. Bill for the last date of service when
you actually saw the patient.
.............................
SERIOUSLY, MEDICARE DOES ALLOW FOR BILLING ON INCOMPLETE ORDERS DUE TO
DEATH. DOCUMENT HOW FAR THE PROS WAS WHEN THE PATIENT DIED, AND REDUCE YOUR
CHARGES.
..................................

It is my understanding, coming from experience, that you can bill everything
that you completed up until the date of death. Example, if you finished to
the point of test socket you can bill for the test socket only, and stump
shrinker if involved. If in fact you completed everything, but the patient died
before coming in to be fit, then you are allowed to bill the completed limb.
However; expect a paper audit if that is the extent in which you completed. It
is hard enough to get paid on certain items even on alive people. By the time
Medicare is notified that someone is deceased, your bill would probably be
processed and paid, just watch for something to come back saying that your DOS
and the death date overlap. Just be honest (not implying that youre not!) and
it will all fall into its respective place. Good luck, and let me know what
you decide to do. As in all Medicare terms they are up to interpretation.
........................
Jake, you are correct. I have had the same think happen to me a couple of
time in the last couple of years. Medicare will allow you to bill for your
out of pocket costs where you incurred and invoice. For example, if you had
a C-fab fabricate the socket you can submit this invoice, or if you
customized a foot and don't think it can be reused you can bill for it as
well. Liners that were cut or can't be reused can also be billed. You use
a HCFA 1500 form as you normally would but with supporting documentation and
maybe a summary letter of what you are doing. Medicare has been good at
reimbursing us in this situation. Happy Thanksgiving.


.....................................
Jake:

The link below will provide you with the answer to your question posted
on the list-serve relating to billing when the patient is deceased prior
to delivery. If you would have a problem with the link, the information
can be found in the Medicare Carriers Manual 2005.3.

<URL Redacted>
<<Carriers Manual-Part 3.url>>

(This is the information directly from the Medicare manual, per Jake)

2005.3 Artificial Limbs, Braces, and Other Custom Made Items Ordered But
Not Furnished.--

A. Date of Incurred Expense.--If a custom-made item was ordered but not
furnished to a beneficiary because the individual died or because the order was
cancelled by the beneficiary or because his/her condition changed and the item
was no longer medically necessary or appropriate, payment can be made based
on the supplier’s expenses. (See subsection B for determination of the amount
of reasonable charge.) In such cases, the expense is considered incurred on the
date the beneficiary died or the date the supplier learned of the
cancellation or that the item was no longer medically necessary or appropriate for
his/her condition. If the beneficiary died or his/her condition changed and the item
was no longer medically necessary or appropriate, payment can be made on
either an assigned or unassigned claim. If the order was cancelled by the
beneficiary for any other reason, payment can be made to the supplier only.



Thank you again,Have a wonderful holiday and be safe!
     Jake R. Wood