Responses: patient's refusal to sign

Responses: patient's refusal to sign

Stephan Manucharian

9/10/2010

Hello List.

In response to my question what to do if a patient, although satisfied with
the prosthesis, refused to sign the delivery acknowledgement form demanding
a “free 3-months trial” of the prosthesis, the consensus is that this
situation may be identified with “order canceled by the beneficiary” as
described in Medicare manual.

Medicare addresses payment for custom items ordered but not furnished in
Chapter 15 of the Medicare Benefit Policy Manual. It addresses how payment
may be made if the beneficiary dies, the item is no longer reasonable and
necessary because of a change in the beneficiaries condition, or if the
order was canceled by the beneficiary. The patients refusal would in my
opinion be considered a cancellation. I have pasted below pertinent parts
from the Policy Manual addressing this issue:

  If a custom-made item was ordered but not furnished to a beneficiary
because the individual died or because the order was canceled by the
beneficiary or because the beneficiary’s condition changed and the item was
no longer reasonable and necessary or appropriate, payment can be made based
on the supplier’s expenses. (See subsection B for determination of the
allowed amount.) 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 reasonable and necessary or
appropriate for the beneficiary’s condition. If the beneficiary died or the
beneficiary’s condition changed and the item was no longer reasonable and
necessary or appropriate, payment can be made on either an assigned or
unassigned claim. If the beneficiary, for any other reason, canceled the
order, payment can be made to the supplier only.

Below is a link to Chapter 15 of the Policy Manual. The pertinent section is
20.3.

<URL Redacted>
Other suggestions were to contact a) the local Medicaid office; b) AOPA for
advice; c) bill as allowed and take really good notes, photos etc. This
reply appears to be based on personal experience:
As far as billing you need to contact your Medicaid HMO. In my experience
either they contact the patient and tell them to return and sign or they
will not be eligible to work with another provider because they will not pay
for it.

Thank you all, who responded!

Stephan


--
*Stephan R. Manucharian, M.A., MSc, CP, BOCO
Clinical Director
Orthopedic Arts Laboratory, Inc.
141 Atlantic Ave., Brooklyn, NY 11201
718-858-2400; Fax: 718-858-9258;
<URL Redacted> < <URL Redacted>>

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