[dchavez]

I have been doing billing and coding for a dme for 3 years. Lately, i been having medicare beneficiaries, telling me they had a powerwheelchair delivered to their homes. To make the long story short, the company that issued the pmd is no longer in bussiness, my guess is this company committed fraud. So, with that note. I called medicare and beneficiary anniversary date is coming up,which means they qualify for a new one. Meanwhile,beneficiary needs repairs done to powerchair,and naturally we cannot bill medicare,since we dont have original documentation on file. I really want to help. Has anyone gone through this issue? If so, how do you handle it?

[DMEisgoodfun]

Get documentation to show they currently qualify for the equipment. If you
can't, do it non-assigned with an ABN. Have the beneficiary appeal himself.
I have NEVER seen Medicare deny an appeal when a beneficiary has requested
it. They overturn in beneficiaries favor with zero documentation.

[dchavez]

I see. Most of the people I deal with are Hispanic. How do I help them start the appeal process? Can I download the form on www.noridian.com?

[DMEisgoodfun]

When beneficiaries do it, there's nothing formal. They call Medicare and
tell them they think such and such should be paid for and Medicare starts it
rolling.

[dchavez]

So, just so we are on the right page together, are they apealing for a new pmd? Or for repairs to the owned pmd?

[DMEisgoodfun]

The repairs if you can't get the documentation. New pmd, whole different
story because so few beneficiaries are willing to pay that much money
upfront on non-assigned.

[dchavez]

I See...well thank you very much for your quick reply...