Author Topic: DME Braces  (Read 326 times)

Prakalpb

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DME Braces
« on: May 12, 2020, 01:27:41 PM »
Hello,
Some of my practice claims (DME Braces) are getting denied and insurance asking for the documentation of the name and address of the CMS authorized Originating Site for Telehealth visit.
Could anyone please help me that what type of document(s) do I need to use as the address of the originating site.

Thank You!

Michele

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Re: DME Braces
« Reply #1 on: May 12, 2020, 07:19:32 PM »
If you are billing for DME, how is that telehealth?  Sorry if I'm missing something.
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Prakalpb

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Re: DME Braces
« Reply #2 on: May 13, 2020, 01:46:49 PM »
If you are billing for DME, how is that telehealth?  Sorry if I'm missing something.

Hello,

We are an DME suppliers for Braces, post after having calls with patients regarding their pain in different areas of body, we go ahead and do live transfer call with Medical representative @ Telemedicine. That representative communicate with patient and transfer the call to one of their networking referrring physician. Doctor consult them and complete the script. As an DME suppliers we get the script from Telemedicine with complete chart notes, based upon that we bill the claim to the insurance after delivering the equipments to the patients. Uncertainly, from last few days we are receiving an denial from insurance stating  require "documentation of the name and address of CMS authorized
Originating site for the telehealth visit.
Could you please help us which document we would need to send further to the insurance.

Michele

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Re: DME Braces
« Reply #3 on: May 13, 2020, 07:21:04 PM »
I'm sorry but I'm having trouble understanding what you are saying you are billing for.  Are you billing with the HCPCS code for the braces?
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Prakalpb

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Re: DME Braces
« Reply #4 on: May 15, 2020, 12:12:05 PM »
Yes, we are billing HCPCS for DME - Prosthetics & Orthotics.

kristin

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Re: DME Braces
« Reply #5 on: May 16, 2020, 10:58:17 PM »
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

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Re: DME Braces
« Reply #6 on: May 27, 2020, 02:24:45 PM »
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

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Re: DME Braces
« Reply #7 on: May 30, 2020, 04:24:24 PM »
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.

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Prakalpb

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Re: DME Braces
« Reply #8 on: June 04, 2020, 11:45:05 AM »
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

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Re: DME Braces
« Reply #9 on: June 05, 2020, 08:38:07 AM »
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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Prakalpb

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Re: DME Braces
« Reply #10 on: June 09, 2020, 10:48:51 AM »
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.

Thank You Michele for all your efforts :)