Home Health & Hospice

What if Your Agency Doesn't Carry the Patient's Supply?

Homecare Insider, November 2, 2009

Under the Prospective Payment System (PPS) consolidated billing requirement, an agency must provide all routine and nonroutine supplies that meet Medicare coverage criteria and that staff need to carry out the plan of care.  This can include some nonroutine supplies that do not appear on the approved list.

What happens if the agency does not routinely stock the brand the patient wants?  There is no provision in the PPS that requires an agency to provide a specific brand of a supply.  According to CMS Publication 100-2, Chapter 7, §10.12D, when a patient selects an agency, that patient also chooses to use the supplies and services provided by the agency.  The one exception:  The physician orders a particular brand.  In this case, the agency must provide that supply.

If agency won’t provide the patient’s brand of supply, it should notify him or her up front, preferably at the time of admission.  The patient can choose to use the agency’s brand, to purchase supplies out of pocket, or even to transfer to another agency.

Managing Supplies in the PPS provides the guidance clincians need to manage supplies in the PPS.  Check out this educational booklet.