Re: OPINION- DELIVERING A CUSTOM PROSTHETIC TO A SNF PATIENT

Re: OPINION- DELIVERING A CUSTOM PROSTHETIC TO A SNF PATIENT

Lesleigh Sisson

4/16/2021

Billing for O&P devices while a Medicare beneficiary is in a covered Part A
stay can be confusing. During a covered Part A acute care stay, the
hospital is responsible for all DMEPOS items ordered.
That is not to be confused with a covered Part A SNF. During a covered Part
A SNF stay, the SNF is responsible for the provision of MOST DMEPOS devices
with one exception being that of some prosthetic HCPCs.
The list below contains the prosthetic HCPCs that are NOT billable to the
DME MAC when the patient is inpatient in a SNF:

[image: image.png]
*Learn more about consolidated billing:*

<URL Redacted>

*Both CGS and Noridian have some great tools to determine who is
responsible for reimbursement of any HCPC code during a Part A SNF stay.
The links are below.*

<URL Redacted>

<URL Redacted>
-situations/consolidated-billing/consolidated-billing-lookup

*Please let me know if you have any questions.*

*Lesleigh Sisson, CFom*
702-400-1661

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On Wed, Apr 14, 2021 at 11:46 AM Elizabeth Roof < <Email Address Redacted> >
wrote:

> Our office was referred by an orthopedic surgeon to fit a new amputee with
> a prosthesis and we have been working with the SNF facility that the
> patient is in currently to do so. It has come down to delivering out the
> item and we notified the facility that we are unable to deliver a
> prosthesis to a patient in a part A stay in a SNF bed and the facility is
> responsible for the cost of the item. We told them that we cannot give the
> patient the item until 2 days before he is discharged home and they don’t
> understand this. They want to be able to bill for therapy minutes on gait
> training and teaching him how to properly don/doff the prosthesis. The PT
> called the office today and stated that another local O&P facility in the
> area has delivered items out to them before for patients to complete
> therapy still in the SNF part A stay and she doesn’t understand why we
> don’t do the same. I’ve sent her all the items regarding proper Medicare
> billing practices for SNF stay patients on the Noridian Medicare Portal,
> but I am curious if any other facility has run into this same issue and
> what you’ve done to help educate other medical professionals on the billing
> guidelines we are to follow to stay compliant with Medicare. We of course
> want to continue to see the patient regarding his prosthesis as we have
> finished all fabrication, but also want to avoid improper billing
> procedures set forth by the payer.
>
> Any tips or advice would be greatly appreciated!
>
> Thanks in advance!
>
> Liz Roof,
> Billing Supervisor & Office Manager
> 15418 West Center Road
> Omaha, NE 68144
>
>