Home Health & Hospice Week

Anniversary date change not allowed.

It should become easier in the New Year to secure reimbursement for capped rental durable medical equipment when a patient has an inpatient stay.

Starting Jan. 1, a supplier will be able to change the "from" or anniversary date on a patient's capped rental DME to the date the patient is discharged from the institution, the Centers for Medicare & Medicaid Services explains in Aug. 1 program memorandum B-03-055.

What won't change: If a patient is in a hospital or other institution on the date of billing for an item of capped rental DME, the claim is denied for that month whether the patient was in the hospital for the entire month or not. Conversely, if the patient is home on the anniversary date, the supplier can bill for the whole month even if the patient is in the hospital for part of it, points out Sarah Lott, president of Texas Star Medical Billing Inc. in Vidor, TX.

What will change. Instead of waiting for the next monthly billing date before seeking reimbursement for the capped rental DME item, suppliers now can change the anniversary date to the date the patient is discharged from the institution, and can resume billing monthly on that new date, the memo explains. Suppliers must note the reason for the anniversary date change in the HAO record, Lott points out.

CMS' aim is "to allow companies to get some reimbursement for that partial month," Lott explains. So, a supplier will receive a denial if a patient is in the hospital on the anniversary date as usual. But instead of having to go through medical review or other red tape, the supplier can just rebill for the item using the date of discharge as the new anniversary date, Lott says.

If a supplier knows a patient is in the hospital, it can avoid a denial altogether by billing when the patient is discharged. However, "many providers never know when a patient has been to the hospital until they get a denial," Lott says.

While CMS' intentions are good, the result of this new rule could be chaos, Lott predicts. "Some of these folks are in and out of the hospital real often, which will result in constant changes," she notes. Thus, the new procedures could "be very confusing and complicate things."

DME regional carriers will issue statements about the new rule on their Web sites and listservs and in their bulletins, the memo says.

Claims for maintenance and servicing of capped rental DME will continue to be paid regardless of whether the beneficiary is in the hospital on the anniversary date, CMS adds.

Check Out Examples of New Billing Procedures

CMS offers four examples in the memo to illustrate the new procedure. Here's one:

"A beneficiary receives oxygen on January 1. On February 28, the patient enters a hospital and is discharged March 15."

"In this example, the DMERC would deny a claim dated March 1. The supplier would submit a new claim dated March 15, which would then become the anniversary date for billing purposes. The supplier should annotate the HAO record (field 19 for paper claims) to indicate that the patient was in a hospital on the first claim with the new anniversary date."

Editor's Note: The memo is at www.cms.gov/manuals/pm_trans/B03055.pdf.