Treating Medicare Patients from Outside Your DME MAC Region
O&P’s, physicians, and DMEs can all provide care to a patient who is from outside the DME MAC region in which they are located. This situation most frequently arises when patients travel or reside part time outside of their “home” MAC region and require prosthetic or orthotic (bracing) services.
What You Need to Know
When patients from outside your MAC region come to you for care, you are allowed to provide prosthetic and bracing devices to them.
· You should process the claim based on the patient's permanent residence. This means you bill the claim to the MAC based on the address listed in the patient's Medicare record.
What this Means for You
The fact that a patient comes to you from outside of your DME MAC region does not preclude you from treating that individual. Just remember that you have to bill the patient’s home MAC for the care provided at your facility. The patient’s permanent residence for claim submission purposes is the address listed in the patient’s Medicare profile. If you are dispensing an orthosis, it is especially important in these situations to check whether a same or similar device was dispensed to this patient both in your MAC region and in the region the patient resides to avoid “same and similar” denials.