Billing Non-Assigned, Using ABNs, and Selling at Retail: The Counter to Medicare Cuts

Wed, April 12

Presented by: Jeffrey S. Baird, Esq. and Lisa K. Smith, Esq., Brown & Fortunato

On June 23, 2016, CMS published the July Fee Schedule for DME suppliers … and it is ugly.

The rates encompass the expansion of competitive bid rates to non-CBAs. The cuts range between 45%-59% on common respiratory products, but reach 82% on TENS units and Enteral IV Poles. The bottom line is that Medicare will pay as little as possible for DME. In response, suppliers need to distance themselves from Medicare fee-for-service. This webinar will discuss ways that the DME supplier can accomplish this. For example, the supplier can elect to be nonparticipating and provide DME on a non-assigned basis. Doing so raises a number of questions.

For example:

  • What does it mean to bill non-assigned?
  • If the supplier bills an item non-assigned, then can the supplier set the price without limitations?
  • Can a supplier bill a rental item nonassigned?

Additionally, the supplier can work with hospitals to reduce the incidences of readmissions of patients soon after discharge; to accomplish this, the supplier and a hospital can jointly own a DME operation … or the supplier and the hospital can enter into a collaborative agreement. And yet another approach the supplier can take is to furnish DME that provides a higher profit and discontinue furnishing DME that is unprofitable.


Member: $99.00
Non-Member: $129.00