Skip navigation

Linda Collins Blogger

Same and Similar

Posted by Linda Collins | February 19, 2014


The January 29, 2014 post, “Life Expectancy,” prompted several questions about how to determine if a patient has received the same or similar device in the past. There are steps to follow increase chances of a positive payment.
What does this mean for you?

During the initial meeting, ask the beneficiary about same or similar equipment received from another supplier in the past. Additionally, suppliers should evaluate the patient’s Medicare claims payment history to verify recent purchase of same or similar equipment. The MACs offer suppliers the opportunity to check this information via an Interactive Voice Response system. Check the website for your regional MAC to access the phone number. If the patient has an item that is same or similar to the current item, document what happened to the original equipment and outline the need for a new device.

When contacting the MAC, to obtain same and similar information the following is needed:

  • Provider Transaction Access Number (PTAN),
  • National Provider Identifier (NPI),
  • Last five digits of your Tax Identification Number,
  • Beneficiary’s HICN,
  • Beneficiary’s name,
  • Beneficiary’s date of birth,

According to Medicare, it is the supplier’s responsibility to be aware of the reasonable useful lifetime requirements for the items provided. If the patient has received the same or similar piece of equipment and the item has not reached its reasonable useful lifetime period, the claim may deny as unreasonable and necessary.

You may execute an ABN if the patient has a same or similar piece of equipment within the defined reasonable useful lifetime.


Össur R&R

The Source for O&P Reimbursement & Regulatory News & Analysis

If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at [email protected]