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Medicare Documentation Resources

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.

Advance 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):

 

NCDs

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

 

 

Jurisdiction A

 

Wilfred Mamuya, MD, PhD
Contractor Medical Director

DME MAC
National Heritage Insurance Co.
75 Sgt. Wm. Terry Dr.
Hingham, MA  02043

medicarenhic.com

 

Jurisdiction B

 

Stacey Brennan, MD
Contractor Medical Director

DME MAC
National Government Services
8115 Knue Rd.
Indianapolis, IN  46250

ngsmedicare.com

Jurisdiction C

 

Robert Hoover, MD
Contractor Medical Director

DME MAC
CGS
PO Box 20010
Nashville, TN  37228

cgsmedicare.com

Jurisdiction D

 

Eileen Moynihan, MD & Richard W. Whitten, MD
Contractor Medical Directors

DME MAC
Noridian Healthcare Solutions, LLC
PO Box 6727/ 900 42nd St. South
Fargo, ND  58108

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

Browse Other Resources

General Medicare Requirements
Product-Specific Requirements
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