tci Medicare Compliance & Reimbursement - 2006 Issue 8

Reimbursement: Medicare Reclassifies Timed-Backup Respiratory Assist Devices For Rental Caps

Faulty information from DME regional carriers led to overpayments, CMS allegesBeginning April 1, 2006, Medicare will change the classification system for certain respiratory assist devices that help benes to breathe when their own spontaneous breathing efforts are insufficient. Although the move promises to reduce benes' out-of-pocket costs, it could put a strain on durable medical equipment suppliers who supply such devices.Under the final rule, Medicare will no longer reimburse RADs with bi-level capability and a backup rate as DME items requiring "frequent and substantial servicing." Instead, Medicare will pay for RADs as DME "capped rental" items. The...

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