Wiki Medicare Application CMS 855???

[gr8gal61]

If a provider has an NPI and also an NPI for dme, what form(s) need to be filled out to apply to Medicare? I know the CMS855i however he will be provider implants for ortho type procedures to the physicians so do we have to fill out the CMS 855S in addition?

 

[thomas7331]

What kind of implants are you referring to here? I think of implants and DME as different things. Implants would normally be billed to Medicare by the facility where the procedure is being done, not by the supplier - you would invoice the facility for those if you supply them. Your provider would need to enroll as a Medicare DME provider with the DMERC only if he or she were planning to supply patients directly with covered items such as walkers, wheelchairs, etc.

 

[gr8gal61]

Thomas,
I am talking about ortho type, joint implants, etc. It is considered the "hardware" for the patients. I understand many facilities are having these bundled into their surgery and the physician/surgeon are not getting reimbursed for this when they purchase so several are now looking at going directly to implant vendors.

Thanks

What kind of implants are you referring to here? I think of implants and DME as different things. Implants would normally be billed to Medicare by the facility where the procedure is being done, not by the supplier - you would invoice the facility for those if you supply them. Your provider would need to enroll as a Medicare DME provider with the DMERC only if he or she were planning to supply patients directly with covered items such as walkers, wheelchairs, etc.

 

[thomas7331]

Facility charges for implants are not exactly 'bundled'. Facility claims are reimbursed a little differently than physician claims - although for some types of implants and under certain payer payment methods there may be no line-item payment for the implant, the cost of the implant is still figured into the all-inclusive case rate that is applied to the surgery or surgeries. The payment for the surgery is meant to cover all associated costs. So the facilities ARE getting paid for the implants, it's just not a separate or additional payment.

I'm still not sure I understand - when you say the physicians/surgeons are not getting reimbursed, do you mean that the physicians own the facility and feel that they're not getting paid? Or are these office procedures?

There really is no alternative to having these billed as part of a facility claim. A vendor will not be able to bill these separately - no insurance would pay a separate claim for an implantable device as a DME item, or if they did it would be an error and likely be recovered in an audit so for these types of devices, I wouldn't see any point in having a provider enroll with the payers. The vendor would need to invoice the facility for this.