Resolving a Top Denial for Billing Accessories or Supplies for Beneficiary Owned Equipment

Suppliers must have beneficiary-owned equipment information on file with Medicare Fee-for-Service (FFS) when billing for accessories and supplies for that equipment to prevent denials. Additional documentation is required when supplies and accessories are provided for purchased equipment that is not on file with Medicare FFS. Drugs used with nebulizers or external infusion pumps are considered supplies for covered Durable Medical Equipment (DME).

Denial Process

  • Denials occur if base equipment is not on file, preventing payment for accessories or supplies.
  • Examples of beneficiary-owned items include Positive Airway Pressure (PAP) Devices, Respiratory Assist Devices (BiPAPs), nebulizers, glucose monitors, hospital bed, and humidifiers.
  • To bill supplies for beneficiary-owned equipment, the base equipment information must be on file with Medicare FFS.

Information Required When Billing Accessories or Supplies for Beneficiary Owned Equipment

  • HCPCS code of beneficiary-owned item and approximate purchase date.
  • Example: Bene-owned E0601 pur Jan 2023 (approximate).

Methods for Claims Processing

  • For denials with Reason Code 16, Remark Code M124 on the Remittance Advice (RA):
    • Request a telephone reopening through the Supplier Contact Center (SCC) to add beneficiary-owned equipment information.
    • SCC provides guidance if telephone reopening is unavailable.
    • Submit appeals/redeterminations via NMP appeals process if necessary.
  • Ensure beneficiary-owned equipment information is included in claim narrative.
  • Add required information to claim narratives ONLY until equipment is on file with Medicare.
  • Claims missing necessary elements will be denied.

After Equipment is On File

  • Once beneficiary-owned equipment is on file, subsequent supply claims do not require narrative details.

Avoiding Denials

  • Verify equipment ownership through the same or similar function on the Noridian Medicare Portal (NMP) or Interactive Voice Response (IVR) to prevent denials due to missing ownership indication.
  • Ask questions regarding potential beneficiary-owned equipment at intake.
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