September 15, 2020
Inpatient Hospital/Skilled Nursing Facility (SNF) DMEPOS Claim Submission Reference Aid
Do you need help understanding when a claim may be submitted to the DME MAC, based on the patient's inpatient hospital or Skilled Nursing Facility (SNF) status in myCGS?
Avoid claim denial or an overpayment, by establishing an intake process that identifies patients who may be in a Medicare Part A covered stay and understanding which items may be separately billed. DMEPOS items provided to an eligible Medicare inpatient are generally furnished directly by the facility or under arrangements between the facility and the supplier. Normally in these scenarios, Medicare makes no supplier payment.
After verifying the facility type and patient status in myCGS, determine when the item will be delivered:
- During the hospital or SNF stay?
- On the day of delivery?
- Within two days prior to discharge, for fitting and training or early delivery to the home?
Inpatient Hospital/SNF DMEPOS Claim Submission Reference Aid provides step-by-step instructions on how to determine if an item may be billed directly to the DME MAC for some of the most common inpatient hospital and Skilled Nursing Facility discharge scenarios.
This reference should be used in conjunction with the myCGS Web Portal and the following resources:
- Consolidated Billing Tool
- DME Supplier Manual Chapter 3, Section 8 – Documentation Requirements, Proof of Delivery
- Chapter 6, Sections 11, 12 and 13 – Claims Submission
Print or save the Inpatient Hospital/SNF DMEPOS Claim Submission Reference Aid so that it can be easily accessed when verifying the patient's inpatient hospital or SNF patient status in myCGS.