Billing DMEPOS Items When Patient is in a Hospital

According to Medicare, all DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) devices are to be used by a patient in a home setting. You deliver the item no more than two days/48 hours prior to discharge of the patient exclusively for training. The item remains in the box for the patient to take home.

What happens if the physician requests a post-surgical brace to be delivered to the patient prior to surgery?

The date of delivery becomes your date of service on the claim. The medical necessity of the brace must be documented as present on the date of service. So, if the brace is for post-surgical use, the medical necessity is not present prior to surgery. In this case, the claim will be denied as not medically necessary.

The physician has prescribed a back brace for the patient to use immediately following surgery. Who is responsible for the claim?

The facility is responsible for providing all items the patient needs during the stay. In this case, the hospital will buy the brace and provide it to the patient. No separate claim is allowed.

I delivered a brace to the patient two days before discharge, but the discharge got delayed. Can I still bill for the brace?

The 48-hour rule is firm. If the patient's discharge date is changed, you will need to pick up the brace and then redeliver another one within the two days of discharge. The date of service is the date of discharge.

Does this apply to outpatient surgery?

No. The 48-hour rule applies only to inpatient cases.

Can I deliver a post-op brace to a patient prior to outpatient surgery?

The date of delivery becomes your date of service on the claim. The medical necessity of the brace must be documented as present on the date of service. So, if the brace is for post-surgical use, the medical necessity is not present prior to surgery.

Do the same rules apply to the patient in a SNF?

Yes. More information about products delivered to patients in a SNF can be found here.

What does this mean for you?

Understand the 48 Hour Rule. Be aware that medical necessity must be well documented on the date of delivery, which then becomes the date of service on your claim.

More information about this policy may be found on the:

•  Internet Only Medicare Claims Processing Manual Chapter 20 (download here)
• Internet Only Medicare Claims Processing Manual, Chapter 15 (download here)
• Internet Only Medicare Program Integrity Manual (download here)

A summary of the 48-hour rule can be found here.