Article Detail - JD DME
Providing Accessories or Supplies for Beneficiary Owned Equipment
Suppliers must ensure that the beneficiary information is on file with Medicare Fee for Service (FFS) to avoid denials. Suppliers are reminded that additional documentation is required in situations where supplies and accessories are provided for a piece of equipment not paid for by Fee-For- Service (FFS) Medicare. In addition, drugs used with a nebulizer or external infusion pump would be considered supplies to a covered piece of DME.
Claims for supplies and accessories used with beneficiary owned equipment must include all three pieces of information listed below. Claims lacking any one of the above elements will be denied for missing information with reason code 16, remark code M124.
Resolving denial: Supplier must provide that information to Medicare to place on file. This can be accomplished in the following ways:
- Telephone reopening through the Supplier Contact Center
- Written reopening using the NMP appeals process
The information that must be put on file includes the claim narrative required elements listed below.
Once the beneficiary-owned item is placed on file, subsequent supply claims do not require a narrative.
Claim Narrative Required Elements
- HCPCS code of base equipment; and,
- A notation equipment is beneficiary-owned; and,
- Date beneficiary obtained equipment (approximate)
Good example: Bene-owned E0601 pur Jan 2021
Some common reasons for denials for beneficiary owned equipment not on file.
- Beneficiary purchased equipment prior to becoming Medicare eligible
- Beneficiary purchased equipment with another supplier
- Beneficiary purchased Glucose Monitor (E0607) and then purchased a Continuous Glucose Monitor (K0554) (The supplies for E0607 are not the same codes used with the K0554)
- Narrative does not match base equipment
- Base item coverage criteria not met
Last Updated Tue, 26 Apr 2022 16:28:20 +0000