NHIC FAQs Results

Frequently Asked Questions

Question	DME: Regulations & Guidelines
Is it acceptable to have all new PAP patients sign an ABN at the beginning of therapy stating that if they do not get a face-to-face evaluation or refuse to get the follow-up re-examination by their treating physician between the 31st and 91st day that Medicare will deny the claim?
Answer
No. This is considered a "blanket" ABN if the notice was presented at the beginning of therapy. The supplier may however, after day 60 following the dispensing of the PAP device, present an ABN to the beneficiary if the supplier has knowledge that the beneficiary has not yet met the policy criteria for continued coverage. This ABN should advise the beneficiary that if, by the 90th day of therapy, they do not meet the policy criteria for continue coverage (e.g., adherent to therapy and obtain a follow-up face to face evaluation), Medicare may deny their subsequent claim(s) and that the beneficiary will be liable for payment. Please refer to the Positive Airway Pressure (PAP) Devices - Supplier Frequently Asked Questions - REVISED - July 2009 for additional information. QUIZ
Update/Review Date - 6/24/2010		FAQ Status: none