Reply To: CIDP and Medicare
Medicare Part B has covered my IVIG since my start date in 2003. At no time have any of my treating facilities billed IVIG has Part D.
The people to ask about any type of coverage are the people providing the service. Believe you me, if they have any doubt, they will ask you to sign an Advanced Beneficiary Notice (ABN). If they do not ask you to sign an ABN, take your pick- 1, they forgot. 2. They know they’ll get paid.
Generally speaking, if an ABN is required and Medicare will not cover the service, the first time notice sent to you will say something like this: “Medicare does not cover this service. It looks like you did not know Medicare would not cover this service. You are not responsible for these charges.”
Don’t try it again, though. Medicare now knows you have been told.
I believe it is factually incorrect to state you must be bed-ridden to qualify for Medicare home based infusion. Yep, been there, done that to. The term I’m familiar with is ‘homebound.”
As defined by Medicare: “Normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber or to attend religious service. A need for adult day care doesn’t keep you from getting home health care.”
However, reporting you do your own shopping will get you punished. Yep, a personal anecdote.
A short review- “For a patient to be eligible to receive covered home health services under both Part A and
Part B, the law requires that a physician certify in all cases that the patient is confined to his/her home. For purposes of the statute, an individual shall be considered “confined to the home” (homebound) if the following two criteria are met:
1. Criterion One: The patient must either: – Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence OR – Have a condition such that leaving his or her home is medically contraindicated. If the patient meets one of the criterion one conditions, then the patient must ALSO meet two additional requirements defined in criterion two below.
2. Criterion Two:- There must exist a normal inability to leave home; AND – Leaving home must require a considerable and taxing effort.
Read all about it here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c07.pdf
Again, this is not your main area of focus. This is the providers problem to document, if they want paid.