decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2003 / B-03-055
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Article Overview
This article explains a CMS Program Memorandum affecting Medicare claims processing for durable medical equipment, prosthetics, orthotics, and supplies during inpatient stays. It addresses Common Working File crossover editing, related DMERC claim handling, and implementation guidance for billing situations involving inpatient discharge timing, capped rental items, and maintenance/servicing. It is relevant to DME suppliers, Medicare claims staff, and billing teams that work with institutional stay scenarios and carrier edits.
Why This Topic Matters
It helps readers understand a Medicare claims-processing update that can affect whether DMEPOS claims are paid or rejected when a beneficiary is in an inpatient stay. The memorandum also includes operational guidance and implementation timing that can matter for suppliers, carriers, and billing workflow.
Article Sections
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General Information
Background and policy context for DMEPOS payment handling when a beneficiary is institutionalized. The section outlines the scope of the memorandum and the general framework for monthly billing during inpatient stays.
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Business Requirements
System and carrier requirements related to CWF crossover editing and DMERC claim processing. This section also addresses how the memorandum is to be communicated through carrier web postings, bulletins, and listserv notices.
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Supporting Information and Possible Design Considerations
Supplemental implementation guidance and clarifications tied to the business requirements. It covers broader applicability, special billing timing considerations, and the handling of end-of-month anniversary dates.
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Examples
Illustrative scenarios showing how the memorandum applies across different inpatient-stay timing patterns. The examples are used to clarify billing cycle effects and claim timing under various month-to-month situations.
What You Will Learn
- How CMS describes DMEPOS payment handling during inpatient stays
- What claim-processing changes were directed for crossover editing
- Which operational areas were affected for DMERC billing workflows
- What implementation and communication steps were required for carriers
- How the memorandum frames billing timing for monthly DMEPOS claims
Who Should Read This
- Medicare billing staff
- DME suppliers
- Durable medical equipment claims processors
- Carrier and contractor operations teams
- Revenue cycle professionals
Modifiers Discussed
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