Abbreviations: AMP = Amputee Mobility Predictor, COM = center of mass, COP = center of pressure, DMERC
= Durable Medical Equipment Regional Carrier, DR = dynamic response, GRF = ground reaction force, ICC = intraclass correlation coefficient, MFCL = Medicare Functional Classification Level, PVD = peripheral vascular disease, SACH = solid ankle cushion heel, SAFE = stationary attachment flexible endoskeleton, SD = standard deviation, SEW = Symmetry in External Work, TTA = transtibial amputation, VA = Department of Veterans Affairs.
But if a physician chooses not to have a DMERC number, patients--many of whom are elderly--must bear the burden of procuring the device and getting reimbursed for it later.
In response to complaints from physicians about having to obtain a DMERC number for the sole purpose of dispensing pessaries, the CMS is considering dropping the requirement.
Few SNFs have expertise with the complexities involved, with most Part B bills processed currently by Durable Medical Equipment Regional Carriers (DMERCs), a group of four insurance companies contracted by HCFA to process Part B claims.
HCFA assigned DMERCs to process Part B claims from suppliers and to educate them on proper billing procedures.
"Prior to the implementation of, for example, a surgical dressing medical policy by the DMERCs," says McKesson's Blanchfill, "fraud, abuse and misunderstandings about billing of surgical dressings under Medicare Part B were running rampant.
The Office of Inspector General recently praised DMERCs for their program integrity efforts, which have resulted in reduced incidence of fraud, abuse and honest mistakes, especially for complicated procedures.
As it stands now, while DMERCs are concerned about ensuring that services are medically necessary and properly documented, they have not been concerned about the payment delays that can result from returning bills to suppliers or facilities.
These claims will have to be resubmitted by the SNFs and reexamined by the DMERCs, a process that will increase costs for both.
To HIDA and our members, it looks as though the billing expertise that Part B suppliers have developed over the years will be wasted--this, despite the fact that these suppliers have worked with the DMERCs to meet regulations ordered by HCFA to standardize billing procedures and medical necessity policies, and their efforts have been judged successful.