W hen patients covered by Medicare Part A need pressure-reducing support surfaces, hospitals and skilled nursing facilities are financially responsible for acquiring and supplying the appropriate products. Hospitals receive the single all-inclusive Diagnosis Related Group (DRG) payment, which applies to each patient based on his/her major diagnosis. Likewise, skilled nursing facilities receive all-inclusive per diem payments based on the Resource Utilization Group, which applies to the patient. Therefore, both hospitals and skilled nursing facilities must select the pressure-reducing support surface that will provide the most cost-effective clinical outcome during a patient’s Medicare Part A covered stay.
When a patient is discharged to the home setting, or converts from Medicare Part A to Medicare Part B, the Local Coverage Decisions (LCDs) for pressure-reducing support surfaces and Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedules take effect. Each of the four Durable Medical Equipment Regional Carriers (DMERCs) publishes these LCDs — one for each pressure-reducing support surface group (I, II, and III). Wound care professionals who order pressure-reducing support surfaces for patients covered by Medicare Part B must totally understand the three LCDs that apply to the three groups of support surfaces.
Each Durable Medical Equipment (DME) supplier that provides pressure-reducing support surfaces to patients covered by Medicare Part B has the responsibility to:
• Obtain a written signed and dated order before the support surface is delivered
• Be sure the patient’s condition qualifies for the pressure-reducing support surface that was ordered
• Verify that the patient’s medical record includes a care plan that includes the support surface that was ordered
• Deliver the pressure-reducing support surface for which the patient qualifies.
The DME supplier must be a prudent purchaser when acquiring pressure-reducing support surfaces. The Medicare-verified Pressure-Reducing Group I Support Surface Product Classification List by specific brands can be found at: http://www2.palmettogba.com/classifications/group%201%20support%20surfaces.pdf. The Group II and Group III Product Classification List by specific brands can be found at: http://www2.palmettogba.com/classifications/group%202%20and%203%20support%20surfaces.pdf. (Hyphens in web addresses are for formatting purposes only.)
The Medicare Part B payment to DME suppliers is limited by the DMERC Fee Schedule established for each state. Table 1 shows the national 2005 DMEPOS Fee Schedule monthly rental ceiling and floor payment limits. For the exact DME monthly rental payment rate in an individual state, contact your DMERC for your state’s 2005 DMEPOS Fee Schedule. - OWM