Ordered but not Delivered

The Scenario: Your patient needs a custom item, artificial limb or brace. You spend significant time fabricating this custom device. You have the patient in your schedule next week for final fitting and delivery.

The Twist: The day before the scheduled appointment, you receive a call from the patient’s spouse who tells you the patient is in the hospital with a serious illness and will no longer need the custom item.

What does this mean for you?

According to the Medicare Supplier Manual, Chapter 5, if a custom-made item is ordered but not furnished because of (1) the patient’s death, (2) a change in the patient’s condition or (3) the beneficiary cancels the order, Medicare may pay for your expenses. In such cases, the expense is considered incurred on either:

• The date the patient died;
• The date you learned of the item’s cancellation; or
• The date that you learned that the item was no longer reasonable and necessary or appropriate for the patient’s condition.

The Medicare allowed amount is based on the services furnished and materials used, up to the date you learned of the patient’s death or of the cancellation of the order or that the item was no longer reasonable and necessary or appropriate.

The DME MAC determines the services performed and the allowable amount appropriate in the particular situation, taking into account any salvage value of the device.

You may submit your claim in the usual manner, with necessary claim elements. Of course, detailed documentation is required to support the claim.

So, delivery or no delivery, you may have the option to get paid for time and materials.