[nklukas]

All,

Can we bill Medicare without an order and without an ABN? I have heard several opinions about this issue but would like to see something in writing. I checked the DMEMAC Supplier Manual Jurisdiction C which states one must have an order prior to billing Medicare. However, further in the chapter there are instructions for billing Medicare without an order.

One of our locations dispensed a hospital bed to a beneficiary's family member without a physician's order and without an ABN. The family member paid for the services. I realize we should pursue an order and qualifying information and bill, but the family refuses to involve the physician. And, what if we cannot obtain an order? Thank you!

[leejgbt]

You could argue that the transaction was between you and the family member, not the bene. Just be aware that if the bene asks you to bill Medicare you are obligated to do this.

I once sold a cane to a guy who was 30ish and gave no indication it was for a Medicare beneficiary. This bene found out Medicare would pay for canes and insisted I bill Medicare. After talking to Medicare and JCAHO it was determined I was obligated to bill. Needless to say, with no RX and no ABN it was a "CO" denial. I never billed the patient for this cane. I did NOT refund to the family member either.

[DMEisgoodfun]

The bene has a right to receive the bed without going thru Medicare. I
wouldn't pursue an order and medical necessity if the family has expressed a
desire to not involve the Dr. Ideally, your staff would've gotten an ABN up
front and the bene would've indicated on the ABN that they didn't want MC
billed. If this were an ongoing rental, I would protect my business and get
an ABN signed for future months rental.

[danielh]

At A Region B Council meeting several years ago, we were told that we should not be submitting a claim to Medicare if we do not have a dispensing order (which can be verbal, if it's followed up with a written order).

[Regina]

I attended an Andrea Stark seminar yesterday, and she stated the we should get an ABN to protect ourselves in case the patient changes his or her mind.

Amazing that we have to do paperwork even when people are giving us cash!

[Sleeping410]

If you are not going to / do not want to bill Medicare, you should always have a claims filing waiver from the patient. Otherwise, the patient may come back to you at a later date and ask for this item to be billed to Medicare.

[afiel]

If the family doesn't want to get the physician involved and you can't get an order you must have them sign an ABN. I do not know of any exception to this rule. They changed the ABN to include Option 2 which allows you to provide the equipment and not bill. This doesn't mean you can't also bill. If you choose to bill so that the family gets an EOB you would add an EY and GA mods. The EY indicates you don't have an order and the GA indicates you have an ABN.