Aren’t SCD products a part of my Global Fee?
Global Fees generally include only CPT codes and supplies such as suture, dressings, staples, wires, drains, casts, splints etc. SCD products are classified as DME products and are billed with HCPC billing codes, which fall outside the global fee.
Are SCD products considered DME products?
Yes. Pneumatic compression devices and the SCD products appear on the CMS “Center for Medicare and Medicaid Services” web site classified under DME which is to be billed under HCPC codes.
Why can’t our facility bill SCD products, but Advanced Medical Solutions can?
Generally, your facility can’t bill DME products to insurance carriers due to your insurance contracts, which usually contain one of the following: global fees, DRGs, or designation as a Part A provider. As a licensed Medicare DME provider, Advanced Medical Solutions is a Part B provider and falls outside the global fees and DRGs.
Is it legal for Advanced Medical to bill SCD in our facility?
DuraMed will act as a contracted vendor to your facility, providing SCD products to your patients. Since the facility will not have financial interest in the program, no anti-kickback laws will apply. This is a convenient and cost-effective way for your patients to get the SCD products prescribed by the physician to aid in their patients’ recovery. However, the surgery center should check their contract or work with their administrator to ensure that these services are not already included in their global reimbursement rate.
What do you charge for the SCD products?
We bill Workers’ Compensation and all commercial insurances according to our contracted rates. Where we do not have a contract with an insurance carrier, we bill according to the Medicare fee schedule, which contains reasonable and customary charges.
Will my patients be billed for the use of this equipment?
Whether DuraMed is in-network or out-of-network with the patient’s insurance, we will accept the assignment of benefits from the patient’s insurance company and follow the contractual responsibilities set forth in the patient’s insurance policy, with no balance bill to the patient. Should insurance or third party payer deem the charges are “not medically necessary, investigational or experimental,” the patient will not be held responsible for those charges.