Long-Term Care

Ostomy, urological, and tracheostomy supplies: An easier approach to Part B billing

LTC Educator's Corner, November 2, 2009

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Similar to Part A services, facilities can bill Part B ostomy, urological, and tracheostomy supplies directly to their Fiscal Intermediary/Medicare Administrative Contractor (FI/MAC).
 
Since SNF business offices are familiar with this process, billing for these supplies is not as labor-intensive and time-consuming as billing for other Part B items. Ultimately, billing Part B ostomy, urological, and tracheostomy supplies can generate revenue for a SNF without the problems that can accompany other supply billing procedures.
 
Familiar billing process
Although a facility can bill Part B ostomy, urological, and tracheostomy supplies directly to their FI/MAC using the UB-04, the Part B billing requirements differ from those of Part A.
 
Part B requires line-item date-of-service billing. This means each supply, accompanied by the corresponding HCPCS code and service date, must have its own line on the bill.
 
Since ostomy, urological, and tracheostomy supplies are considered prosthetic or orthotic devices, revenue code 274 must be included for each item on the claim.
 
Medical necessity and coverage requirements
Billing for ostomy, urological, and tracheostomy supplies involves a wide variety of items. For example, covered ostomy supplies typically include:
  • Ostomy faceplates
  • Pouches
  • Adhesives
  • Barriers
Part B–billable urological supplies include:
  • Insertion trays
  • Catheters
  • Collection devices
Since Medicare only covers certain items associated with tracheostomy care provided to SNF residents, facilities should only bill for a limited number of tracheostomy supplies, such as care kits.
 
But before submitting Part B claims for these supplies, SNF billers must ensure that the criteria for medical necessity and coverage requirements are met.
 
Medicare Part B covers:
  • Ostomy supplies provided to a SNF resident with a surgically created opening to remove waste, such as urine or fecal matter, from the body.
  • Urological supplies provided to a resident with permanent urinary incontinence or permanent urinary retention.
  • Tracheostomy care kits provided to a SNF resident after a surgical tracheostomy. The tracheostomy must be expected to remain open for a minimum of three months.
Supplies not essential to these processes are considered medically unnecessary and, therefore, not covered by Medicare.
 
Although CMS’ NCDs establish basic coverage criteria for services and supplies, many FIs and MACs have created more detailed requirements. These LCDs can be found on contractors’ Web sites and often require additional documentation to support the medical necessity of a service or supply. If a biller is aware of this requirement, he or she can inform the clinical staff about what is needed and, ultimately, avoid problems before they occur.
 
Detailed documentation
All ostomy, urological, and tracheostomy supplies require a physician’s order, which should be as specific as possible. The physician’s order must specify the type and quantity of supplies. Any change in supply type or increase in supplies requires a new order. You must have clinical supporting documentation for each supply.
 
Before submitting a claim, check that all diagnosis codes are appropriate for the services being billed. If you have any questions about diagnosis codes, documentation, or the physician’s orders, seek assistance from the clinical staff.
 
Given the detailed documentation and facilitywide cooperation needed, billing your FI/MAC for Part B ostomy, urological, and tracheostomy supplies is truly a team effort.
 

Additional education
HCPro, Inc. offers many educational tools to help master the billing for Medicare Part B including HCPro’s Medicare Boot Camp – Long-Term Care Version which covers the Medicare rules and regulations applicable to skilled nursing facilities. The objective of this four-day course is to provide course participants with a detailed understanding of the Medicare "rules" with a particular emphasis on the operational application of those rules. Billing for ancillary services under Medicare Part B is just one agenda item covered during the four-day course. Make sure your facility isn’t leaving money on the table. At the end of the course, you’ll be able to:

  • Identify services billable by a SNF to Medicare Part B
  • Identify the component parts of a NCD
  • Identify billing requirements for Pneumoccoccal pneumonia, Influenza, and Hepatitis vaccinations
  • Define a DME MAC
  • Identify coverage of DMEPOS in a nursing facility
  • Describe the difference between claims that are submitted to the DME MAC vs. the FI



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