Billing > Billing

DME Braces

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kristin:
The POS for DME braces always has to be 12, for Home. That said, not sure what is happening here...in order to dispense DME, patient needs to sign a form that says they actually got the DME item. Is that the issue?

An originating site is where the patient physically is when the telehealth call is being made. It can be home, doctor's office, etc...

Prakalpb:
As per CMS guidelines patient's 'Home' is not considered as a valid Originating Site for Telehealth Services and my practices' most of the claim has denied for proof of Originating Site address or additional information.
Could anyone please tell me which document is required to substantiate 'Originating Site' information, because patients were at home during Telemedicine service.

Michele:
I'm sorry but I'm having trouble following you.  The originating site refers to the location of the Medicare beneficiary (patient).  I'm not sure what "document" you need and I still don't understand why you are billing telehealth for DME.  You say you are billing for the DME, but you are doing a telehealth visit.  Are you using the DME HCPCS code for these sessions?  I really can't help because I don't understand what you are looking for.

Prakalpb:
Not an issue :)

Could you please throw some light on the detailed explanation of 'Originating Site' as prescribed by Medicare for Telehealth Service(s).
Also, please tell me which document can be used as 'proof' to show the Originating Site of a patient at the time of services in case insurance deny the claim billed for Telehealth Service.

Thank You!

Michele:
From:  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf

An originating site is the location where a Medicare beneficiary gets physician or practitioner medical
services through a telecommunications system. The beneficiary must go to the originating site for the
services located in either:
● A county outside a Metropolitan Statistical Area (MSA)
● A rural Health Professional Shortage Area (HPSA) in a rural census tract

I am sorry but I do not know what can be used as proof.  I researched it and nothing comes up.  I have never encountered a situation where they requested proof of the originating site.

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