Vice President-mom & pop DME
We are a mom and pop DME company which specializes in ostomy care. As you know ostomy care falls unders the consolidated billing. When we give patients ostomy supplies we always call to get an eligibility. Many times the Home Health episode does not show up as soon as they go under the Home Health episode. Later on we get recouped and when we approach Home Health agencies their respond is they did not order these supplies from us therfore will not pay for them. Home Health agencies do not report to Medicare as soon as an episode begins therfore eligibilities are not current. We can give out supplies on Monday and patient can go into episode on Tuesday which falls into the span dates and we get denied and Home Healths agencies will tell us that they did not have the patient on this date. Meanwhile it gives us a higher denial rate than necessary. I believe this needs to be revised!First, Ostomy is under wound care and this is not a wound. At times the skin is irritated but it is not a wound. Second, Home Health agency need to report to medicare the day a person is taken in (episode), and not wait until they decide to bill. We need to have the information as soon as possible in orde to best serve the patient. Thirdly, ostomy supplies need to be revisited; a trache is not under consolidated billing and an ostomy is. Very much the same.