WHAT WE KNOW SO FAR
Many of you are excited about the Lymphedema Treatment Act and the possibility of Medicare paying for your lymphedema garments. Unfortunately, there is still a lot that is up in the air and that we do not know at this time. But first, let’s go over what we do know. Beginning January 1st, compression garments for lymphedema will be eligible for coverage by Medicare. The new coverage includes :
- Standard fit daytime and nighttime garments and Custom Compression Garments
- Gradient Compression Wraps with adjustable traps
- Bandaging Supplies for treatment phases
- Accessories like donning and doffing accessories
To qualify, patients must have a lymphedema diagnosis and a prescription for these supplies. CMS (Center for Medicare & Medicaid Services) released a Medical Learning Network article detailing the implementation of this new coverage. This article will explain further the areas of coverage and limitations on garments. We know that Medicare under Part B plans to cover 80% of the reimbursement rate after deductibles are met. What we don’t know at this time is what those reimbursement rates will be.
STILL WORKING ON
Medicare has yet to determine how much it will reimburse the provider for these items. These rates have yet to be established, which may take a while. They are looking at using Medicaid reimbursement rates, and some of these rates are very low, less than the wholesale price of quality garments. Since there is no standardization for compression garments in this country, anything can pass a compression stocking. Some companies may sell cheaper garments in order to be able to bill Medicare for you.
Still, another area we don’t know enough about is the documentation that Medicare will require to pay for these garments. Just because a garment is eligible for reimbursement does not mean it will get paid. Correct coding, diagnosis, and documentation will need to be provided; some of this is still to be determined.
Medicare is divided into territories around the country. I understand that each of these areas will come up with its own pricing structure, documentation, and requirements for that area. According to one resource, this process could take as long as 150 days. However, the other day, I got another notification from a different entity that said this was not true and that they would be ready on January 1st. Again, so much is still up in the air, and I am curious to know who is correct; we may know more after the first of the year.
WE’RE GETTING CLOSER
We’re getting closer! Being we are dealing with the government, sometimes those wheels turn slowly. Hopefully, the transition for the Lymphedema Treatment Act will be smooth and straightforward. I will continue to keep you informed to the best of my ability. As more information is available, I will pass it on to all of you.
WORKING WITH YOU
I am currently working on updating all my coding per Medicare’s new codes. However, I am not set up to bill Medicare at this time. To bill Medicare, you have to be licensed; at this time, I do not know of licenses for selling compression stockings. I have heard that USMCA is working with Medicare to create a license, but that is still in the works. There are also many fees and qualifications or hoops to jump through, and I am looking into these to determine if this will be feasible for my business. Those who are eligible at this time are those who are accredited DEMOS suppliers. I am looking into other options and plan to continue to work with you and your therapists to do all I can to help you get into good-quality compression garments.
The five major manufacturers of compression garments for lymphedema are working together to help us navigate the transition for The Lymphedema Treatment Act. They are calling themselves The U.S. Medical Compression Alliance or USMCA. They have put on a few presentations to explain where the process stands. They recorded their last presentation so that more people could access this information. Here is the YouTube link if you want to learn more.
CMS is also hosting two informative webinars to address questions from providers about this new coverage. You can register for these sessions and submit your questions in advance.
My original goal in starting The Compression Closet was to help those who did not have coverage for compression garments for lymphedema. Even though Medicare is now going to provide some coverage, there are still those who do not have any coverage, and I don’t want to abandon them or my original objective. I will continue investigating these matters and do my best to develop a viable solution to serve those in need. Thank you for your patience, your understanding, and your business. I appreciate all of you and the opportunity you have given me to be of service.
Disclaimer – This post is for general information. Furthermore, the information contained in this blog is not a substitute for medical advice. Always consult a licensed healthcare professional for advice on your specific condition.