Provider Compliance Tips for Hospital Beds and Accessories

Provider Compliance Tips for Hospital Beds and Accessories

MLN Fact Sheet      ICN 909476     February 2018

 
PROVIDER TYPES AFFECTED

Physicians and other practitioners who write requisitions or orders for hospital beds and accessories

 BACKGROUND

The Medicare Fee-For-Service (FFS) improper payment rate for hospital beds and accessories for the 2017 reporting period was 78.5 percent, representing a projected improper payment amount of $66.2 million and accounting for 0.2 percent of the overall Medicare FFS improper payment rate.

 REASONS FOR DENIALS

During the 2017 reporting period, the majority of improper payments for hospital beds and accessories were due to insufficient documentation.

 TO PREVENT DENIALS

The following conditions must be met:

1. General Requirements for Coverage of Hospital Beds A physician’s prescription and such additional documentation as the Medicare Administrative Contractor (MAC) medical staff may consider necessary, including medical records and physicians’ reports, must establish the medical necessity for a hospital bed due to one of the following reasons:

1. The patient’s condition requires positioning of the body; for example, to alleviate pain, promote good body alignment, prevent contractures, and avoid respiratory infections, in ways not feasible in an ordinary bed
2. The patient’s condition requires special attachments not fixable nor used on an ordinary bed.
    

2. Physician’s Prescription The physician’s prescription, which must accompany the initial claim, and supplementing documentation when required, must establish that a hospital bed is medically necessary. If the stated reason for the need for a hospital bed is the patient’s condition requires positioning, the prescription or other documentation must:

• Describe the medical condition (for example, cardiac disease, chronic obstructive pulmonary disease, quadriplegia, or paraplegia)
• Describe the severity and frequency of the symptoms of the condition that necessitates a hospital bed for positioning
• If the stated reason for requiring a hospital bed is the patient’s condition requires special attachments, the prescription must:

Describe the patient’s condition Specify the attachments that require a hospital bed

3. Variable Height Feature
In well documented cases, the MAC medical staff may determine that a variable height feature of a hospital bed is medically necessary and, therefore, covered, for one of the following conditions:

• Severe arthritis and other injuries to lower extremities; for example, fractured hip. The condition requires the variable height feature to assist the patient to ambulate by enabling the patient to place his or her feet on the floor while sitting on the edge of the bed.
• Severe cardiac conditions. For those cardiac patients who are able to leave bed, but who must avoid the strain of “jumping” up or down.
• Spinal cord injuries, including quadriplegic and paraplegic patients, multiple limb amputee, and stroke patients. For those patients who are able to transfer from bed to a wheelchair, with or without help.
• Other severely debilitating diseases and condition, if the patient requires the variable height feature to ambulate..
   
  4. Electric Powered Hospital Bed Adjustments The Medicare may cover electric powered adjustments to lower and raise head and foot when the MAC medical staff determines that:

• The patient’s condition requires frequent change in body position, and/or
• The patient may need an immediate change in body position (no delay is tolerable), and
• The patient can operate the controls and cause the adjustments.
   

*Exceptions may be made to this last requirement in cases of spinal cord injury and brain damaged patients.

 

1. Side Rails If the beneficiary’s condition requires bed side rails as an integral part of or an accessory to a hospital bed, Medicare can cover bed side rails.
   RESOURCES

FOR MORE INFORMATION ABOUT...	RESOURCE
The 2017 Medicare Fee-For-Service Supplemental Improper Payment Data	https://www.cms.gov/Research-Statistics-Da­ta-and-Systems/Monitoring-Programs/Medi­care-FFS-Compliance-Programs/CERT/CERT-Re­ports-Items/2017-Medicare-FFS-Payment-Data. html?DLPage=1&DLEntries=10&DLSort=0&DLSort­Dir=descending
National Coverage Determination (NCD) for Hospital Beds (280.7)	https://www.cms.gov/medicare-coverage-database/ details/ncd-details.aspx?NCDId=227&ncdver=1&b­c=AAAAgAAAAAAAAA%3d%3d&

 

 

Medicare Learning Network® Product Disclaimer

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS)






Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.