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Linda Collins Blogger

Lost, Stolen, or Irreparably Damaged Items

Posted by Linda Collins | November 08, 2017

According to the CMS Benefit Policy Manual (Internet-only manual 100-02), Chapter 15, Section 110.2.C., payment may be made for replacement of a device in the case of loss, theft or damage. The replacement refers to an identical item.

Recent audit results from the MACs indicate that claims are being denied because documentation does not support the brace was lost, stolen or irreparably damaged in a specific incident. If you are replacing a device for one of the above reasons, make sure your documentation and the corroborating documentation, provide details about the incident.

In the case of loss or theft, you want to describe the situation, indicated the continued need for the brace, and make sure medical necessity is well documented. A physician's prescription is required to support the continued medical need of the brace. If the brace is stolen, include a copy of the police report. You may want to include a patient statement with an explanation about the situation.

If the brace is determined to be beyond repair, your notes will need to detail the exact nature of the damage and why it is not able to be repaired. Remember, Medicare uses the 60% rule in determining whether to pay for repair or replacement. If the repairs on the brace cost more than 60% of the allowable amount for a new brace, they will pay for the new brace. Again, a physician's order and corroborating documentation is needed.

More information about replacements can be found here

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