We know the situation all too well. Customer rents equipment. Customer enters a skilled nursing facility (SNF) during the rental period. Supplier doesn’t get paid for the months where the skilled nursing facility is responsible for the customer’s medical needs, including your equipment the customer left in their home. However, suppliers can often recover those missed rental months after the SNF discharges the customer even if the initial capped rental period is expired.

Next Episode: Thursday, August 22, 2024

To do so, suppliers must complete four steps:
  1. Establish the customer continued to use the equipment after discharge.
  2. Secure an updated order from the prescribing physician or authorized healthcare provider.
  3. Create a new sales order in the billing system to generate new billing months.
  4. Add a payment extension request narrative to claims generated after the initial capped rental period ends.
Establish Continued Use Suppliers must determine the customer used the rental equipment for the originally prescribed condition in the last 12 months. Suppliers can bill for any months the customer used the equipment after SNF discharge, up to the maximum number of allowed payments, even if the use occurs after the end of the initial rental cycle. For example, say a supplier only received 10 payments in a 13-month CPAP rental cycle because the patient was in a SNF for three months. The supplier realizes several months after discharge from the SNF the patient is still using the CPAP for the originally prescribed reason. They may be able to extend the initial rental period and get paid for usage months until the total number of payments equals 13. If, on the other hand, the customer has not used the equipment in the previous 12 months, Medicare will not reimburse for missed payments. Suppliers can pick up their equipment since Medicare never reimbursed the full purchase price and the equipment still belongs to the supplier. Secure an Updated Order From the Prescribing Practitioner Suppliers must have an active order from the physician dated within 12 months of any service dates billed. While the supplier may need to secure a new order to extend billing, they do not need a new delivery ticket. Create a New Sales Order in the Billing System Most billing systems require a new sales order to generate claims after the expiration of the original rental period. The original sales order is presumably closed. In creating the new record, suppliers should take care to enter the proper dates so as not to create more invoices than are billable. Continuing the example above, the supplier is only eligible for three additional payments. They do not want the new order to create thirteen rentals because this is not a new encounter. Add a Claim Narrative to Extend the Rental Period For all claims billed after the initial rental period, suppliers should add a claim narrative to request an extension. The narrative usually reads, “Please extend the CMN payments due to a break in billing.” We hope this brief refresher will help your billing team recapture missed payments following any gap in billing.