Need a Medicare Guru for my question.

[PsychNurseWannaBe, BSN, RN]

Hi,

I have a lady resident who has an ostomy. She now has a rash around the stoma. The MD spoke with resident and says to change the wafer everyday. Resident replies that Medicare will not pay for her supplies like that if changed daily. If the MD writes an order that says, resident to change wafer daily as needed... do you think Medicare will be OK with that and pay it?

Thanks for your help.... greatly appreciate Medicare nurses!!

~Psych

[nratchet]

Hi,

I have a lady resident who has an ostomy. She now has a rash around the stoma. The MD spoke with resident and says to change the wafer everyday. Resident replies that Medicare will not pay for her supplies like that if changed daily. If the MD writes an order that says, resident to change wafer daily as needed... do you think Medicare will be OK with that and pay it?

Thanks for your help.... greatly appreciate Medicare nurses!!

~Psych

First...is resident currently in a facility under Medicare skilled? If so, Medicare should pay for enough supplies to change wafer daily because part A Medicare is all inclusive. We're not sure about the coverage in the community.

[edhcinc]

Hi--this is a website (commercial) which lists the standard coverage for ostomy supplies under Medicare Part B (prosthetics) from the MC suppliers manual.

http://elitemedical.com/covforosit.html

This is the website for one of the DMERCs, Administar, where you can read all of the "official" information--

http://www.adminastar.com/Providers/DMERC/medicalpolicy/suppmanualbychapters.cfm

Effective 2006, DMERCs agreed that MC pays for 20 wafers/drainable pouches per month with no question. If there is medical necessity, MC will pay for more with proper documentation (physician description of need).

Good luck!

[PsychNurseWannaBe, BSN, RN]

Many thanks to both of you!!

[CapeCodMermaid, RN]

First...is resident currently in a facility under Medicare skilled? If so, Medicare should pay for enough supplies to change wafer daily because part A Medicare is all inclusive. We're not sure about the coverage in the community.

I believe the patient's supplies would come out of the daily medicare rate the facility is getting paid.

[edhcinc]

CLARIFICATION--

1. if an inpatient in a SNF under Med A, all supplies are included in the daily rate.
   
2. if in the community with Med B coverage, ostomy supplies are paid for as prosthetics, with eligibility and certification criteria. The allowed amount/number of each item needed is proscribed, but the amount/number can be increased if physician documentation supports the medical necessity.

:whe!: