Kesling Home Health Care
800.358.4514
Patient Liability for Non-Covered Services

When assignment is accepted or not accepted on a claim, suppliers may bill beneficiaries for services that are denied as non-covered services.  While assignment agreement prohibits suppliers from collecting more than Medicare’s allowable charge for that service, it does not prohibit billing for non-covered services.  Billing non-covered services applies to services that are never covered by Medicare such as services that are occasionally denied as “not medically reasonable and necessary”.

When accepting assignment, before furnishing services which a supplier believes are excluded from coverage as not “reasonable and necessary”, that supplier will inform the beneficiary of the non-covered service.  For services rendered prior to receiving documentation to determine if services are excluded, the supplier will then inform the patient of the charge for that particular service.


Necessity and Reasonableness

Although an item may be classified as Durable Medical Equipment, it may not be covered in every instance.  This equipment must also be necessary and reasonable for treating the injury or illness, or it must improve the functioning of the beneficiary to be considered covered.  Payment of equipment that does not reasonably perform a therapeutic function for the individual cannot be authorized.  Furthermore, when the type of equipment furnished substancially exceeds what is required for the treatment of the illness or injury involved, payment will be reduced to the least expensive equipment that will meet the patients needs.

Signature Requirements

The supplier may obtain from the patient and retain on file a lifetime authorization for the submission of  equipment rental and/or purchase claims in the patients behalf.  When a beneficiary’s signature is required and he/she is unable to sign, we can accepts the following:

•a signature marked with the patients sign and witnessed by   another individual.
•A claim signed by another person.  The person signing MUST be the patients POA and should sign the patients name, his/her own name, address, and relationship to the patient .

Durable Medical Equipment

In an attempt to provide greater efficiency in Medicare programs as they apply to Durable Medical Equipment, effective October 1, 1993, the HCFA awarded contracts to four health care carriers.  These four carriers are referred to as Durable Medical Equipment Regional Carriers or DMERC’s.  These DMERC’s can process only claims for DME and will make payment to only the patient and DME supplier.

Returns

Private pay merchandise may be accepted for exchange or refund within 30 days of purchase when accompanied by the receipt and in the original undamaged packaging.  Refunds are subject to management discretion.

Oxygen contents and disposable supplies WILL NOT be accepted for return, refund, or credit.

Billing and Payment Policies

Kesling Home Health Care  accepts assignment from Medicare and most other insurance companies on behalf of their patients for services provided.  All Medicare Part “B” claims are filed electronically.  Once Medicare has been billed and their portion has been paid Kesling Home Health Care will bill supplemental insurances and the patient for any unpaid portion.
Medicare
Kesling Home Health Care may accept Medicare Part “B” assignment, billing Medicare directly for 80% of the allowed amount and billing the beneficiary or supplemental insurance for the balance.  The Medicare part “B” deductible is currently $134 per calendar year.  The deductible is taken as Medicare processes them, not necessarily according to service date.
Kesling Home Health Care will provide equipment to Medicaid recipients upon verification and approval of coverage status and medical justification.  Presentation of your State Benefits ID and personal ID will be required.
Medicaid
Kesling Home Health Care may bill private insurance upon verification and approval of coverage status and medical justification.  The patient/client is responsible for providing all necessary insurance information.  Presentation of your insurance card and personal identification are required when billing private insurance carriers.
Private Insurance
Managed Care
Kesling Home Health Care will upon approval and authorization from the managed care provider, accept assignment of managed care claims for processing once all appropriate identification has been established.
The deductible will not be waived under any circumstance.  A monthly payment will suffice if full payment is unable to be made. 

The coinsurance may be waived only on rental items if the patient has been billed 3 times and document they are still in need of the equipment and not financially able to pay their share.  A letter substantiating that the patient is unable to pay must be written and signed by the patient, and the patient  must also understand that if at any time their ability to pay changes, they are obligated to pay.
Waiver of Deductible and Coinsurance