Medicare has specific guidelines that all durable medical equipment (DME) providers — like Apria Healthcare — must follow when billing Medicare patients for home medical equipment (HME) and related supplies. Below are some resources to help.
Medicare Documentation Resources
Advanced Beneficiary Notice of Non-Coverage
If coverage is in question, the DME provider is required to issue a standard notice to the Medicare patient BEFORE providing that item or service. This notice is called an Advance Beneficiary Notice of Non-Coverage or “ABN.” The ABN allows the patient to decide upfront whether or not he or she would like to accept financial responsibility for the item or service, if Medicare does not pay.
The ABN is required in order to bill the patient or his/her co-insurance if Medicare denies coverage. It also serves as proof that the patient knew PRIOR to receiving the item or service that Medicare might not pay.
Medicare coverage criteria can be referenced in the National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs):
An ABN must be issued when:
- It is believed that Medicare may not pay for the Medicare covered item or service, or
- Medicare may not consider the covered item to be medically reasonable or necessary
DME Medicare Administrative Contractors
Detailed education is available from the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) serving Jurisdictions A, B, C, and D.
DME MACs provide education in a variety of formats including: self-paced online tutorials, podcasts, video education, and webinars.
|
DME MAC JURISDICTIONS BY STATE |
|
| Jurisdictions | States |
| A | Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont |
| B | Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin |
| C | Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, West Virginia |
| D | Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming |
DOWNLOAD
| DME MAC Jurisdiction A Facts DME MAC Jurisdiction B Facts DME MAC Jurisdiction C Facts DME MAC Jurisdiction D Facts Government Medicare DME MAC Jurisdictions info page |
JURISDICTION AWilfred Mamuya, MD, PhD DME MAC medicarenhic.com |
JURISDICTION BStacey Brennan, MD DME MAC ngsmedicare.com |
JURISDICTION CRobert Hoover, MD DME MAC cgsmedicare.com |
JURISDICTION DEileen Moynihan, MD & Richard W. Whitten, MD DME MAC medicarenhic.com |
Medicare Screening List
Apria’s Medicare Screening List is a free reference tool we’ve created for healthcare providers to use when ordering home healthcare services and equipment.
Please use this guide to find out which durable medical equipment items are covered under Medicare and the specific reimbursement criteria for each item.
Please be aware that reimbursement guidelines do change. As new rules or guidelines take effect, you can count on Apria to be your information resource. As of this printing, the Medicare guidelines herein are accurate and complete. However, if you have any questions, feel free to call your local Apria Healthcare branch.