If a custom DME product, such as a Rx brace or diabetic therapeutic shoes/ inserts, are not picked up by a patient what is the recourse the provider has regarding billing? I understand that when a patient is deceased or there's been changes in deformity based on the initial DME product prescription that billing can be provided for invoice cost. But in this case, if the product is never picked up by the patient, what is the best practice for this situation? Can you bill the patient at all at a certain time frame, that is, 60 or 90 days of having the DME in the office and have already been invoiced by the vendor and yet have not billed insurance because it was not dispensed.
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We need to separate this out as some DMEPOS you noted are not custom while others are.
Salvage value is the key issue to understand as non-custom items have a value, that is they can be used on another patient or they can can be returned to the vendor. The return fee and shipping fee are unfortunately your problem. This is true for a myraid of DMEPOS such as heat molded inserts, night braces, cam boots, therapeutic shoes, etc. T
As for the custom fabricated items (custom molded or milled inserts) or custom AFOs these are made for a single unique patient and thus cannot be used on anyone else. Thus they have no salvage value.
As for custom fitted items, these are prefabricated and until the actual time of delivery, when they are custom fitted and delivered, they are considered pre-fabricated and have a salvage value.
As to when you can charge for a custom item not delivered, the appropriate Date of Service is when you came to know that the item was cancelled by the patient or that medical necessity is no longer needed.
Three different examples:
Your office calls today and informs them that their toe filler (L5000) is ready for pick up. They tell your office they had a BKA. The DOS is today.
You need to submit a claim with a narative describing your costs and the facts
why medical necessity is no longer being met.
Your patient is contacted to pick up their off the shelf shoes and heat molded inserts.
They come in and tell you they "don't want those ugly shoes".
There is salvage value and you can't bill the carrier.
Your patient is contacted to pick up their off the shelf shoes and custom molded inserts and they say they don't want those ugly shoes.
There is no salvage value in the inserts as they were made for that one specific patient, but the off the shelf shoes can be dispensed to another patient. Hence here you can bill for the inserts, but not the shoes. If the shoes were custom made or had a custom modification made, that would be another story, which would need to be explained to the carrier.
WIth the costs of products it is important that providers be very careful about dispensing custom DMEPOS to patients, especially those who have very different levels of expection from reality.
For more information, check out the following: https://med.noridianmedicare.com/web/jadme/claims-appeals/billing-situations/canceled-orders-for-customized-items
WIthin this article is a URL to the CMS Internet Only Manual with a lenghty discertation on how to handle this.