Billing: Keep eligibility rules in mind

Q. What are the rules for supplying to patients who are in a SNF or who are receiving home health care?
Friday, May 24, 2013

A. Many denials stem from a patient being admitted into a skilled nursing facility (SNF) or having a home health episode. Although some of these denials are unavoidable, it is important to know the difference in guidelines and what is and is not covered in these situations.  

Certain items are covered for Medicare beneficiaries who are in a SNF. Whether they are covered or not depends on the status of the covered Medicare Part A stay. If a patient is in a SNF, many DME items are not covered as they are considered part of the SNF consolidated facility charges. Those items include, but are not limited to, the following: wheelchairs, oxygen and oxygen equipment, hospital beds, walkers, negative pressure wound therapy pumps and pressure reducing support devices.

Keep in mind that the patients are eligible for 100 days of coverage as an inpatient in a SNF per benefit period. During this period, Medicare will only cover customized prosthetic devices.

After the 100 days is up, Medicare will consider coverage on the following supplies while the patient is in a SNF: therapeutic shoes and inserts, dialysis supplies, parenteral and enteral nutrition, ostomy supplies, surgical dressings, urological supplies and trach care kits.

If a patient is receiving home health care it is basically the opposite of the SNF rule. Medicare will not cover supplies such as catheters, tracheostomy care kits, ostomy supplies, etc., while a patient is receiving home health care. These items are billed by the home health agency providing the care. However, those patients might qualify for certain DME, such as wheelchairs, hospital beds, walkers, etc.

Kelly Wolfe is president of Regency Billing and Consulting. Reach her at or 727-286-6102.