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CVI and Lymphedema Patient Bill of Rights - Part II - Page 6

© Linda Bily

Provider's of DME equipment may not be held liable for fraud or otherwise when a patient obtaining equipment, and/or supplies for treatment of lymphatic and vascular disease, but has no signs or symptoms of such disease, when the DME lymphatic and vascular specialist has submitted a written letter to the ordering physician stating that the patient does not appear to have any signs or symptoms of vascular or lymphatic disease. The ordering physician is to be held liable for the accuracy or his or her diagnosis, treatment plan, and treatment ordered, regardless of the DME lymphatic and vascular disease specialists recommendations, as the final determination in making an accurate diagnosis, and treatment ordered is the physicians.

Each request for prior authorization shall include a written physician's order, and a physician's letter of medical necessity, including an outlined long-term disease management plan specific to each patient's needs, lifestyle, physical ability to apply treatment as ordered, risks if disease is not treated effectively, and prognosis with effective treatment.

DME Companies providing IPC (Intermittent Pulse Compression or DVT pumps), or aircasts in lieu of lymphedema pumps, or billing items not supplied or items are supplied that do not fit the FDA description or code description of billed item shall be held liable for fraud. DME companies engaging in providing financial or monetary compensation to physician's in exchange for fraudulent diagnosis or referrals shall be held liable for fraud. Lunches for in-services, or gifts during the holidays costing $100.00 or less are not considered financial or monetary compensation. DME companies billing for items that have not been delivered, with the exception of custom fit items refused by the patient after custom measurements were provided will be held liable for fraud. DME companies providing equipment or supplies for providing equipment or supplies for patient's who do not display signs or symptoms common to lymphatic or vascular disease but have been diagnosed by a physician with lymphatic or vascular disease, as the liability for fraud lies with the diagnosing physician

DME companies may submit claims for custom fabricated items upon providing measurements, and are not required to provide actual delivery in order to submit billing. However, items must be ordered within twenty four hours of acquiring the measurements on custom fabricated items with a patient's acceptance and/or signature assigning benefits, and shall be provided to the patient within five business days upon the custom fabricated garment's arrival, or otherwise according to the patients availability.

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