Home Health & Hospice Week

There's good reimbursement news for DME suppliers that have seen claims denials for manual wheelchairs with tilt-in-space under K0009.

The durable medical equipment regional carriers should recognize and pay the miscellaneous code for such wheelchairs now, said a Centers for Medicare & Medicaid Services staffer in a June 4 Open Door Forum for home health and DME. So suppliers should resubmit previously rejected K0009 claims, the official advised.

Likewise, if suppliers were renting the items under the capped rental category, they now can submit claims for purchase under K0009 and receive the allowable minus the amount they've received so far for the rental, the official said. If suppliers submit a claim for the item with code E1161, the DMERCs automatically will convert it to a K0009 claim and pay it.

CMS is switching this and some pediatric wheelchairs from the capped rental to the routinely purchased category in July. At that time, E1161 will become a purchased rather than rented code (see pdf of Eli's HCW, Vol. XII, No. 18, p. 139).

Suppliers, however, continue to have lingering questions over the specifics of the billing method. "We will still have to know exactly how they want us to process," says Peggy Walker with Waterloo, IA-based rehab network U.S. Rehab. "Saying it and processing the claim will be a different scenario."


Next Year Will Bring New CMN Guidance On Repairs

CMS revealed in the forum a few nuggets of guidance regarding an upcoming policy on DME repairs, scheduled for publication in January.

Suppliers don't have to obtain a certificate of medical necessity for general repairs to a piece of equipment purchased by Medicare, a CMS official explained. But if a beneficiary obtained the equipment before becoming Medicare-eligible, then needs repairs to the equipment that are now covered by Medicare, CMS will require a CMN.