OSTOMY SUPPORT GROUP OF BEAVER COUNTY

                                                                            Documentation Requirements from Medicare

 

       For those of you who are regular members of our support group, you are aware of the supplies we have on hand that are free for you to take advantage of. Many of these supplies are do­nated by families of ostomates who have passed. As Kathy Hoffman can attest (as she is the one who is usually the recipient of these), the donation is evidence of over stock piling of the ostomate when ordering their monthly allotment. Because abuse in this process the Center for Medicare & Medicaid has come up with new guidelines (2013) to limit the number of sup­plies sent out. Most insurance companies follow these guidelines. Hence, suppliers may be ask­ing how many appliances you have on hand when placing your order. Here are the rules for sup­pliers when they are processing your order:• When products are supplied as refills to an original order, an order by the beneficiary must be placed within 14 days prior to dispensing the refill. It cannot be more than 10 days before the current supply runs out. Suppliers cannot ship on a predetermined basis, even if authorized by the beneficiary to do so. This shall be done to ensure that the refilled item are reasonable  and necessary, and that the existng supplies are approaching exhaus­tion.Suppliers must not dispense a quantity of supplies exceeding a benef iciary's expected utili­zation. They must stay attuned to unusual utilization patterns. And they must verify with the physician that any changed utilization is warranted.What this means is that if you have enough appliances on hand you may not receive the total allotment indicated by the monthly ordering quotas. We all know that there are times when you can go through appliances at a faster rate than usual, especially during flu season. Keep this in mind when you are placing your order. But do not be fearful and stockpile supplies. This is where the abuse comes in. Also keep in mind that the appliances have expiration dates.Below is the recommended monthly allotment for the most commonly used supplies:

 

• Skin Barriers (wafers) -  20 per month      

• Pouches, drainable -   20 per month   

• Pouches, closed - 60 per month

• Urinary pouches  -20 per month       

• Stoma caps  -  31 per month     

• Ostomy irrigation bag -  2 per  6 months

• Ostomy irrigation cone -  2 per  6 months  

• Irrigation sleeve  -  4 per  month

• Bedside drainage bag - 2 per  6 months     

• Skin barrier wipes - 150 per 6 months  Ostomy belt - 1 per month

• Ostomy skin barrier powder 10 oz. per 6 months

    If you have any questions or concerns please contact your medical supplier or your can contact the customer   

   service of the manufacturer whose appliances you use.