Furnishing Items to Inpatients

Furnishing Items to Inpatients
By: Todd A. Moody, Esq.

Earlier this year, in the Medicare Quarterly Provider Compliance Newsletter issued by CMS, the topic of coverage for DMEPOS furnished to inpatients was addressed. This came on the heels of a report issued by the OIG at the end of 2018 about the extent of improper payments made by CMS for DMEPOS furnished to beneficiaries during an inpatient stay in a hospital or other similar facilities. OIG’s report states that it detected $34 million in improper Medicare Part B payments to DMEPOS suppliers for 120,614 claims for DMEPOS items furnished to beneficiaries during inpatient stays. With this in mind, let’s review the rules related to DME and beneficiaries admitted to facilities as inpatients.

Medicare Part A pays Acute Care Hospitals, Long Term Care Hospitals, Inpatient Rehabilitation Facilities, Inpatient Psychiatric Facilities, and Critical Access Hospitals using a variety of methodologies. These include the Inpatient Prospective Payment System, the Prospective Payment System, and the Reasonable Cost Basis. The amounts paid to the facilities under each of these Part A payment methodologies, however, is considered payment in full for all of the products and services furnished to a Medicare beneficiary during an inpatient stay—including any DMEPOS items furnished to the beneficiary. If a beneficiary needs an item of DMEPOS during an inpatient stay, the facility must furnish the item or arrange for a supplier to furnish the items. If arrangements are made for a supplier to furnish the item, the facility will pay the supplier and include the item on its claim or report to Medicare. Medicare does not make any separate payment for the furnished items.

But there are some cases when it is appropriate for a DMEPOS supplier deliver an item to a beneficiary who is still an inpatient at one of the Part A facilities. Medicare will pay for an item delivered before a patient is discharged when the following conditions are met:

• The DMEPOS supplier delivers the item to the beneficiary solely for training or fitting of the item, and the item is for subsequent use in the beneficiary’s home;
• The beneficiary is being discharged to a place of service that qualifies as the beneficiary’s home and not to another inpatient facility or Skilled Nursing Facility;
• The supplier may deliver the item no earlier than two days before the beneficiary’s discharge date;
• The supplier must not furnish the item in order to eliminate the inpatient facility’s responsibility to furnish it; and
• The supplier may not submit a claim to request payment for the item until after the facility discharges the beneficiary.

Remember these limitations and requirements when working with facilities and their discharge planners to furnish items to beneficiaries before they are discharged from an inpatient stay.

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Todd A. Moody, JD, is an attorney with the Health Care Group at Brown & Fortunato, PC, a law firm based in Amarillo, Texas. He represents pharmacies, infusion companies, HME companies and other health care providers throughout the United States. Mr. Moody can be reached at (806) 345-6332 or tmoody@bf-law.com.