home health supplies

Published

This may be a dumb question considering its so late into PPS, but I need some clarification.:uhoh3: Can anybody tell me if we get any reimbursement for medical supplies. I have tried to look up the regulations and see conflicting and confusing wording. What's the use of having routine and non-routine supply lists if everything is bundled? Can anyone give me a link to the routine supply list? I can only find the non-routine. Can we bill for the lancets and chemstrips since it falls under DME and how are they billed? Our RHHI is Palmetto. Any help is appreciated. Thanks

Up Vote Up Vote ×
Specializes in Vents, Telemetry, Home Care, Home infusion.

palmetto home health reference guide: 300+ pages:

http://www.palmettogba.com/palmetto/providers.nsf/attachments/85256d580043e75485256ecc004caf6e/$file/home+health+manual+rev062006pdf.pdf

could not locate supply list

mc regs: starts pg 77

http://new.cms.hhs.gov/manuals/downloads/bp102c07.pdf

50.4.1.3 - nonroutine supplies (reportable)

(rev. 1, 10-01-03)

a3-3119.4.a.2, hha-206.4.a.2

nonroutine supplies are identified by the following conditions:

1. the hha follows a consistent charging practice for medicare and other patients receiving the item;

2. the item is directly identifiable to an individual patient;

3. the cost of the item can be identified and accumulated in a separate cost center; and

4. the item is furnished at the direction of the patient's physician and is specifically identified in the plan of care.

all nonroutine supplies must be specifically ordered by the physician or the physician's order for services must require the use of the specific supplies to be effectively furnished.

the charge for nonroutine supplies is excluded from the per visit costs.

examples of supplies that can be considered nonroutine include, but are not limited to:

1. dressings/wound care • • • • • • • • • • • •

  1. sterile dressings;
  2. sterile gauze and toppers;
  3. kling and kerlix rolls;
  4. telfa pads;
  5. eye pads;
  6. sterile solutions, ointments;
  7. sterile applicators; and
  8. sterile gloves.

2. i.v. supplies

3. ostomy supplies

4. catheters and catheter supplies

  1. foley catheters; and
  2. drainage bags, irrigation trays.

5. enemas and douches

6. syringes and needles

7. home testing

    1. blood glucose monitoring strips; and
    2. urine monitoring strips.

    consider other items that are often used by persons who are not ill or injured to be medical supplies only where: • •

    1. the item is recognized as having the capacity to serve a therapeutic or diagnostic purpose in a specific situation; and
    2. the item is required as a part of the actual physician-prescribed treatment of a patient's existing illness or injury.

    for example, items that generally serve a routine hygienic purpose, e.g., soaps and shampoos and items that generally serve as skin conditioners, e.g., baby lotion, baby oil, skin softeners, powders, lotions, are not considered medical supplies unless the particular item is recognized as serving a specific therapeutic purpose in the physician's prescribed treatment of the patient's existing skin (scalp) disease or injury.

    limited amounts of medical supplies may be left in the home between visits where repeated applications are required and rendered by the patient or other caregivers. these items must be part of the plan of care in which the home health staff is actively involved. for example, the patient is independent in insulin injections but the nurse visits once a day to change wound dressings. the wound dressings/irrigation solution may be left in the home between visits. supplies such as needles, syringes, and catheters that require administration by a nurse should not be left in the home between visits.

    50.4.2 - durable medical equipment

    (rev. 1, 10-01-03)

    a3-3119.4.b, hha-206.4.b

    durable medical equipment which meets the requirements of the medicare benefit policy manuals, chapter 6, "hospital services covered under part b," 80, and chapter 15, "covered medical and other health services" 110, is covered under the home health benefit with the beneficiary responsible for payment of a 20 percent.

    we have a dedicated supplier: sterling medical that our agency has contract with to provide our non routine supplies. diabetic testing supplies now covered under mc part b...because of copay and pts ongoing need after we discharge, agency prefers we set up with local dme company or sterling to obtain supplies.

    remember need to list items on plan of treatment in order to bill mc ---list under section 14 plan if using old 485 pot type format (paper form mc used to require agency's to use).

    list comes out every oct from mc with supplies covered, code and price they will pay.

    my intermediary, cahaba has an easier to read hh reference guide:

    https://www.cahabagba.com/part_a/education_and_outreach/educational_materials/hh_coverage.pdf

    see section 240 [color=#231f20]coverage guidelines for specific supply items

    [color=#231f20]

    [color=#231f20]

    cim (cms pub.6, 60-11)

    [color=#231f20]

    [color=#231f20]

    the home blood glucose monitor is considered durable medical equipment (dme) and may be provided and

    billed by the dme supplier. the balanced budget refinement act of 1999 excluded dme from the consolidated

    billing requirements of home health prospective payment.

    240.75

    [color=#231f20]covered medical supplies

    [color=#231f20]

    [color=#231f20]

    the following

    [color=#231f20]catheter supplies [color=#231f20]are covered under the medicare home health program:

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]catheters (all types) [color=#231f20]- [color=#231f20]urinary drainage bag

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]catheter plugs [color=#231f20]- [color=#231f20]sterile leg bags

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]catheter trays [color=#231f20]- [color=#231f20]irrigation solutions (including commercially prepared irrigants)

    [color=#231f20]

    supplies used for

    [color=#231f20]dressing changes and wound care [color=#231f20]may include, but are not limited to:

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]adhesives [color=#231f20]- [color=#231f20]drapes, sterile

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]cotton-tipped applicators,sterile [color=#231f20]- [color=#231f20]eyepads

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]gauze, iodoform [color=#231f20]- [color=#231f20]gauze, fine mesh

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]gauze, kling [color=#231f20]- [color=#231f20]stockinette dressings

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]suture/staple removal sets [color=#231f20]- [color=#231f20]non-prescription antibiotic ointment

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]gauze, vaseline [color=#231f20]- [color=#231f20]reston

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]gauze, sponges [color=#231f20]- [color=#231f20]tape, adhesive

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]gauze, sterile [color=#231f20]- [color=#231f20]tape, hypoallergenic

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]gauze, stretch [color=#231f20]- [color=#231f20]tape, twill

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]gloves, sterile [color=#231f20]- [color=#231f20]telfa

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]kerlix [color=#231f20]- [color=#231f20]wound irrigation and cleansing supplies (betadine solution,

    [color=#231f20]

    h2o2, normal saline, skin soaps, detergents)

    [color=#231f20]

    -

    [color=#231f20]sween and carrington products [color=#231f20]- [color=#231f20]montgomery straps

    [color=#231f20]

    [color=#231f20]

    dressings not containing prescription medications (duoderm, op-site, vigilon, comfeel, dermagranspray, synthaderm, xeroform, coloplast, envision, restore, intact, hydrogran, all carrington products,

    sorbsan, sween-a-peel, debrisan, tegaderm, and mesalt)

    [color=#231f20]

    the following list includes

    [color=#231f20]enteral and parenteral [color=#231f20]tubing and [color=#231f20]venipuncture [color=#231f20]supplies:

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]needles [color=#231f20]- [color=#231f20]bulb/piston syringe

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]syringes [color=#231f20]- [color=#231f20]iv tubing

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]feeding stomach tube [color=#231f20]- [color=#231f20]vacutainer

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]gavage bags [color=#231f20]- [color=#231f20]vacutainer needles

    [color=#231f20]

    [color=#231f20]

    miscellaneous

    [color=#231f20]supplies include:

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]anti-embolism stockings (e.g., ted, jobst) [color=#231f20]- [color=#231f20]slings

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]stump socks [color=#231f20]- [color=#231f20]drying agents for decubitus care astringent/antiseptic

    [color=#231f20]

    preparations (i.e., treatment of hemorrhoids)

    [color=#231f20]

    -

    [color=#231f20]antihistamine/antipruritic lotions [color=#231f20]- [color=#231f20]suction catheters

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]nonprescription ointments [color=#231f20]- [color=#231f20]shampoo (non-prescription types for treatment of lice, eczema, or other skin disorders)

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]enema administration kits [color=#231f20]- [color=#231f20]premeasured disposable enemas

    [color=#231f20]

    -

    [color=#231f20]ostomy supplies and dressings

    [color=#231f20]- [color=#231f20]tracheostomy care trays

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]elastic bandages (unless used to hold dressing in place)

    [color=#231f20]

    240.80

    [color=#231f20]routine medical supplies

    [color=#231f20]

    [color=#231f20]

    supplies that are not separately covered under the medicare home health benefit include:

    [color=#231f20]

    -

    [color=#231f20]swabs, alcohol preps, and skin prep pads [color=#231f20]- [color=#231f20]non-sterile applicators

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]4x4s [color=#231f20]- [color=#231f20]sween and carrington products

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]tape removal pads [color=#231f20]- [color=#231f20]masks

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]aprons [color=#231f20]- [color=#231f20]specimen containers

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]adhesive and paper tape [color=#231f20]- [color=#231f20]tongue depressors

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]diapers [color=#231f20]- [color=#231f20]disposable underpads

    [color=#231f20]

    [color=#231f20]

    -

    [color=#231f20]gowns [color=#231f20]- [color=#231f20]thermometers

    [color=#231f20]

    hope this helps.

    Up Vote Up Vote ×
    Specializes in Vents, Telemetry, Home Care, Home infusion.

    not covered:

    240.50 [color=#231f20]prescription dressings

    [color=#231f20]prescription dressings are not payable because medicare considers any dressing that contains a prescription medication

    [color=#231f20]to be a drug, and, therefore, not reimbursable (e.g., garamycin dressing).

    240.55 [color=#231f20]granulex

    [color=#231f20]granulex is a biological and not a supply. medicare does not provide coverage.

    240.60 [color=#231f20]proderm

    [color=#231f20]proderm is not covered by medicare. it is not effective for the treatment of decubitus ulcers. refer to the medicare ncd manual, (cms pub. 100-3, ch.1 270.4, not yet available).

    240.65 [color=#231f20]procuran

    [color=#231f20]procuran is not covered by medicare because it is a biological and not a supply. however, medicare will review skilled nursing visits to perform wound care using procuran following usual guidelines.

    [color=#231f20]the application of procuran does not determine the need for skilled care.

    Up Vote Up Vote ×
    + Join the Discussion