Billing Medicaid Patients for DME in NY State

bsmith307

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I work for a small durable medical equipment supply company in western NY state. The business model is "stock and bill" - we provide DME (braces, crutches, slings, et cetera) to orthopedic practices, emergency departments and the like. They provide the patient info and we bill the insurances. We are NOT considered primary for Medicaid but can bill them when they are the secondary carrier.

To make a long story short, I need to know when we can legally bill patients for DME not covered by Medicaid - if ever. Short of having a signed agreement with the patient prior to dispensing the DME (which we can't control considering our business model) I don't believe we can bill Medicaid patients - regardless of whether they have that coverage as primary, secondary or other.

Any guidance would be greatly appreciated!
B
 

spatterson8317

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Dme

You might check with your local Medicaid office. I know when I was doing DME in Texas, as long as we had a signed wavier from the patient saying they are aware that the item might not be covered by Medicaid with the reason why we thought it would not be covered, (not a covered item under the policy, patient not room confined some point in the day, patient met the max. benefit for surgi-lube, etc.) and the patient signed it. WE would bill medicaid, get the denial and then be able to bill the patient for the item. Now, there are some policies that would allow you to bill the patient first as that is a private agreement between your company and the patient and can over ride the agreement the patient has with the insurance. I would check with the Local Medicaid office and ask what they do, but that is how we did things when I did DME. Some of the policies will have a Waiver for this type of issuse and you can send in the waiver with the claim to the insurance. Hope it helps :)
 
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