Medicare Documentation Resources

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):

NCDs

LCDs

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.

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.