Billing Process Medicare & DME | Pharmacy Compliance Series [Podcast]

In our latest Pharmacy Compliance Series podcast, Lisa Faast with DiversifyRx and  Jeff Hedges from R.J. Hedges & Associates discuss the complexities of billing for Medicare Part B, specifically related to Durable Medical Equipment (DME) supplies.  Jeff explains that transitioning to the DME side requires pharmacies to understand and follow different rules compared to traditional pharmacy practices.  The key points discussed include the use of standard written orders instead of prescriptions, the importance of collecting HCPC codes and modifiers for accurate billing, the elimination of certain paperwork by Medicare, and the need to dispense according to Medicare's requirements rather than specific brand preferences.   Additionally, they emphasize the significance of proper documentation, such as detailed product descriptions, and the availability of billing companies that can help process claims correctly.

Pharmacy owners are urged to recognize the differences between pharmacy and DME billing, ensure their billing companies have the necessary tools and knowledge, and comply with Medicare's guidelines.  The elimination of certain paperwork and the requirement to dispense within Medicare's allowable fees are highlighted, along with the option to use advanced beneficiary notices for patients who desire non-covered products.  The discussion also touches on continuous glucose monitors and the importance of regularly reviewing the Local Coverage Determination (LCD) for updates and compliance.  Overall, pharmacies are advised to stay informed, maintain accurate documentation, and consider reliable resources and software solutions to navigate DME billing successfully.

Mastering Medicare Part B billing for Durable Medical Equipment (DME) is crucial for pharmacies.  Key tips: use standard written orders, collect HCPC codes and modifiers, follow Medicare guidelines, document thoroughly, and leverage billing companies. Stay informed, comply with rules, and explore reliable resources.

Becky Templeton

Becky is a Board Certified DME Specialist and Accredited Business Intermediary. Her education and training background fuels her desire to understand how things work, while trying to get the simplest answers and best methods for implementation. She is the go to woman for R.J. Hedges’ training and the voice of many of our videos.

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