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Frequently Asked Questions (FAQs)
Q: Is this program Legal?
Can a doctor, clinic or Ambulatory Surgical Center
legally dispense, bill and collect for DME
products and services?
A: Yes - The government via the
Federal Register stated on 01/04/01 “In the
interest of patient convenience, we are using our
regulatory authority under section 1877 (b) (4) of
the Act to expand the in-office ancillary services
exception to include certain DME…In so doing, we are
concerned primarily with enabling the patient to
depart from the physician’s office with DME
products.
We are
withdrawing our proposal that physicians not mark up
these items when provided in-office to their
patients; we believe the current DMERC reimbursement
provisions provide sufficient cost containment
controls”.
Q: Will the DME Advanta, LLC.
program meet the guidelines of the Anti-Kickback
Statue and Stark Act?
A: Yes - The business model was
developed to meet all the guidelines under the
federal Anti-Kickback Prohibition and Stark
Self-Referral Prohibition. Numerous policies,
processes and guidelines will be set in place to
ensure full compliance.
Q: Is my current program of a
Stock & Bill (Consignment) legal?
A: No - as of September 8, 2009 Consignment
arrangements are banned, per CMS Ruling
Pub 100-08 Medicare
Program. The purpose of this change request is to define and
prohibit certain arrangements where an enrolled
supplier of durable medical equipment, prosthetics,
orthotics, and supplies (DMEPOS) maintains inventory
at a practice location which is not owned by the
enrolled DMEPOS supplier, but rather, owned by a
physician, non-physician practitioner or other
health care professional for the purpose of
distribution, commonly referred to as a consignment
closet and/or stock and bill arrangement. In
addition, this change request will instruct
physicians, non-physician practitioners or other
health care professional’s practices that use of
consignment closets and/or stock and bill
arrangements (as defined above) must be in
compliance with current standards.
Q: Will my facility need a
license to dispense Durable Medical Equipment and
bill for Medicare Part B?
A: Yes - The Centers for
Medicare & Medicaid Services (CMS) require you
receive a license called the
Provider Transaction
Access Number (PTAN)
Q: Will my facility need
accreditation to dispense Durable Medical and bill
for Medicare Part B?
A:.No - CMS
(Centers for Medicare and Medicaid Services) has mandated that all Medicare
Suppliers that are provide DME supplies and services
out of there office will have not have to
undergo an accreditation process in order to bill
and be paid for DMEPOS.
Q: Must I buy my DME products from DME Advanta?
A: No-you use your current vendors or take advantage
of DME Advanta’s Inventory Group Purchasing
Organization (“GPO”) Buying Membership with a full
line of products to choose from top manufacturers
with below market pricing.
There is no mark up on any DME
products!
Q: What is a “deductible”?
A: This is the contractual
obligation the insurance policy designates that must
be paid by the patient before any benefits will be
paid on any claims it recurs annually.
Q: What does "Co-Pay" mean?
A: This is the portion the
patient is responsible for according to their
insurance policy on each medical service or product
received after their insurance company has processed
their claim.
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