![]() Private payers may develop specific coverage policies outlining the criteria that must be met in order for a procedure or service to be covered. ABF/ROMCare contacts each state program for specific coverage, coding, and reimbursement policies, as well as documentation and other payment criteria. Medicaid coverage and reimbursement varies from state to state. Although Medicare (CMS) does not cover ActiveCare at this time, if a patient has secondary insurance, Medicare may be billed for the purpose of obtaining denial coverage, which may be a prerequisite for the secondary payer. Medicare reimbursement is currently not available however, ABF/ROMCare is actively seeking coverage from CMS. These criteria are derived from national and local Medicare policies, and coverage considerations are reflected in the CMN Certificate of Medical Necessity Form CMS-846. The clinical response to an initial treatment with the device.The reason the device is required, including the treatments that have been tried and failed and.Symptoms and objective findings, including measurements, which establish the severity of the condition.The determination by the physician of the medical necessity of a pneumatic compression device must include documentation of the following: General Coverage Criteria: Pneumatic compression devices are covered only when prescribed by a physician and when they are used with appropriate physician oversight and documentation, i.e., physician evaluation of the patient’s condition to determine medical necessity of the device, assuring suitable instruction in the operation of the machine, a written treatment plan defining the pressure to be used and the frequency and duration of use, and ongoing monitoring of use and response to treatment. The member can properly manage the device.Intermittent limb compression device (includes all accessories), not otherwise specified.In the provider’s opinion there has been an appropriate clinical response, &.The four-week rental trial of the pneumatic compression device was accomplished, &.Once the trials are completed, purchase is covered once the additional criteria below are met: The patient has edema of the affected lower extremity, one or more venous stasis ulcer(s) which have failed to heal after a six-month trial of conservative treatment including a compression bandage system, appropriate dressing for the wound, exercise, & limb elevation. ![]() ![]() The treating doctor makes sure that there has been no significant improvement in patient’s condition or if symptoms still remain even after the conservative therapy ORĪ 4 week trial rental will be covered for Venous Stasis Ulcers if:.The patient have to undergo a four-week attempt of conservative treatment that must include use of an appropriate compression bandage system or compression garment, & elevation of the limb &.For the trial, you must meet criteria: A (1 & 2) or B.Ī 4 week trial rental will be covered for Primary & Secondary Lymphedema if: Pneumatic compression pumps are only covered for purchase when the patient has completed a successful trial. Pneumatic compression device (PCD) are considered as an appropriate treatment for refractory primary & secondary lymphedema, & chronic venous insufficiency with venous stasis ulcers
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |