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Medicare reimbursement


One of our pts has Medicare and had cataract surgery.  Aren't pts entitled to a pair of glasses after cataract surgery?  We started our paperwork process to be non-par providers back in Aug 07!  We barely got a provider number 01/2008!  So...this pt was seen 10/07 and when we billed, DMERC is telling us we didn't have a number then so it was denied.  It wasn't our fault it took them so long to get us a number....please advise.

   Yes, pts are entitled to one pair of glasses following cataract surgery.  That also means that they can get one pair after the right eye is done, and one pair after the left eye is done, if they are done far enough apart to warrant glasses.    Pts can go to non par providers as long as they have a supplier number issued by NSC.  It sounds like they made your supplier number effective after the service date.  When you complete the supplier application it usually takes about 6-8 weeks to process, if everything they need is there.  If they have to request any info that will delay the process. 

I would recommend that you call DME for your region and ask them what date your supplier number became effective and ask them why it was delayed.  If it was something on your end, you probably can't do anything. 

Good luck

Thanks for your help!  Another question regarding this pt...Do you know if we were required to have this patient sign an Advanced Beneficiary Notice of Noncoverage (ABN) even though we weren't participating providers at the time of service??

I believe if you are non par it is not necessary to have the patient sign the ABN, since the patient is paying for the glasses out of pocket, and you are submitting the claim to Medicare for them as a courtesy.



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