decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Durable_Medical_Equipment / Payment_during_a_hospital_stay
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Article Overview
This article explains a Medicare durable medical equipment payment exception that applies when a beneficiary is in a hospital for part of a month. It is useful for DME suppliers, DME MAC billing staff, and reimbursement professionals who need a high-level understanding of how monthly payment timing is affected by hospital stays and discharge-related billing changes. The article presents CMS-based guidance and illustrative scenarios involving recurring monthly billing dates.
Why This Topic Matters
Hospital admissions can affect DME payment timing, so understanding the general Medicare rule and its exception helps billing teams recognize when a monthly claim may still be payable and when billing timing changes after discharge.
Article Sections
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Payment during a hospital stay — an exception to the rule
Introduces the general Medicare rule for DME payment and outlines the special exception addressed by the article. It also frames the month-based timing concept used in subsequent guidance.
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How the anniversary date is used
Describes the role of the initial delivery date and the recurring monthly date used for claim payment review. The section explains the basic timing framework applied by the DME MAC.
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Examples provided by CMS
Presents several CMS examples showing how the payment exception is applied in different hospital-stay scenarios. The examples cover recurring monthly billing adjustments and discharge-related changes.
What You Will Learn
- How Medicare generally handles DME payment during a hospital stay
- What the monthly timing concept means in DME billing
- How hospital discharge can affect recurring claim timing
- What kinds of CMS examples are used to illustrate the rule
Who Should Read This
- DME suppliers
- DME MAC billing staff
- Medical coders
- Revenue cycle professionals
- Reimbursement specialists
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