[DMATOY]

I AM TRYING TO SETTLE A LITTLE "DISPUTE" WITHIN THE OFFICE...
WE HAVE A PT THAT WAS TO DISCHARGE FROM THE HOSP ON 08-26-10 (THUR) AFTER DELIVERING A BI-PAP THE PT WAS HELD UNTIL MON. (08-30-10) FOR SOME REASON .. I REMEMBER AT THE LAST MEDICARE MEETING I ATTENDED THE QUESTION CAME UP ABOUT THE WINDOW IN WHICH YOU COULD BILL FOR EQUIPMENT IF THE PT DID NOT DISCHARGE ON THE ORIGINAL DATE>>>IF I RECALL CORRECTLY YOU COULD BILL WITH THE DELIVERY DATE (WHICH WOULD BE PRIOR TO DISCHARGE) IT WOULD DENY BUT YOU WOULD BE ABLE TO BILL WITH DOCUMENTAION SHOWING THE REASON FOR LATE DISCHARGE AND BE PAID??? COULD YOU HELP ME WITH THIS I CANNOT FIND ANY WRITTEN DOCUMENTATION TO SUPPORT THIS.
THANKS

[DMEisgoodfun]

Bill with date of delivery 8/26/10, since that was the date you were told pt
would discharge. When it denies, send in documentation that shows the
facility changed the discharge date. I haven't had a situation where I could
try this but others have told me they've done it and gotten paid.

[ylbms]

DMEisgoodfun thanks for the info maybe I'll try that next time..we've had patients where orders were delivered and they were not discharged until later. They always deny the claim as patient still being an inpatient. I have never tried to appeal w/ documentation but we usually just adjust off the initial date as still an inpatient and then add on 1 month at the end of the rental to meet 13 months.

[HEATHER]

All info below is from Supplier Manual:

Date of Service for Pre-Discharge Delivery of DMEPOS:
For DMEPOS, the general rule is that the date of service is equal to the date of delivery. However, pre-discharge delivery of items intended for use upon discharge is considered provided on the date of discharge. In this case, the date of service on the claim should be the date of discharge. (Chapter 6)

Re: Capped rental equipment already in the home and subsequent claim denied because patient has entered a snf

If a beneficiary using DME is in a covered Part A stay in a SNF for a full month, Medicare will not make payment for the DME for that month.
If the beneficiary is in a Part A covered stay, but not for the entire month, the discharge date becomes the new anniversary date for subsequent claims. In this situation, you must submit a new claim using the date of discharge as the “from” date. You should note in the HAO record (field 19 for paper claims) that the beneficiary was in a SNF, resulting in the need to establish a new anniversary date. (Chapter 13)