We want to keep you informed of changes that you may not be aware of to Medicare requirements, and the way they process claims for your Ostomy and Urological supplies. This is the page to come to for information on those changes.
Did you Know . . .
All Medicare providers must obtain a detailed written order along with Medical documentation from your physician before supplies can be provided. This documentation may not be more than 12 months old, meaning annual visits with your physician are required.
Medical Record Requirements
Medicare requires that your medical record contain the following information:
- Your condition or diagnosis, and the reason for this condition.
- Notes indicating the continued medical necessity for your supplies.
- The quantity of supplies used as well as the frequency of use. For example, if you are using intermittent catheters, your physician should document in your medical record the number of times per day you are performing intermittent catheterization. Without this information, your claim will be denied, so make sure you discuss your condition with your Doctor every time you visit.
Home Health Care Supply Requirement
If you are under the care of a home health nurse, physical therapist, skilled nursing facility, physical rehabilitation facility, or are in the hospital – you MUST receive all of your ostomy or urological supplies directly from them for the duration that they are caring for you. They are required by Medicare to provide these supplies REGARDLESS of the reason you are under their care. Medicare will not pay for your supplies if you receive them from any other provider. Once you are fully discharged, you will be able to resume ordering your supplies through us.
Medicare has established maximum quantities for the supplies used under the Ostomy and Urological benefits. Even though they may say you can show medical necessity for quantities greater than what they allow, we have never seen them pay for overages. They simply do not accept anything as a valid reason for needing additional quantities. Because of this, we are required to obtain a signed Advanced Beneficiary Notice (ABN) from you prior to providing quantities over their established limits.
Prior to refilling an order for your supplies Medicare requires that every provider contact their customers to determine which supplies are needed and the quantity remaining to determine if a refill is necessary.