TPN

Learning Objectives
Upon completion of this Journal Club the participant will be able to:
1. Describe the different medical supplies categories and what is covered.
2. List the Medicare eligibility criteria for beneficiaries regarding medical supplies reimbursement.
3. Define Medicare assignment and what this means for both the beneficiary and the supplier.

Background Information
We are going to examine the Medicare coverage for medical supplies used in the treatment of diabetes, wound care, ostomy care, urology, incontinence care and enteral nutrition therapy. While Medicare’s medical supplies’ coverage methodology has remained basically the same over the past few years, the details of coverage have continued to evolve. Medical supplies eligible for coverage can be used in a variety of different settings including the acute care hospital, skilled nursing facility, assisted living facility, patient’s home, and in the physician’s office. We will focus on non-acute care.

According to the Centers for Medicare and Medicaid Services (or CMS), durable medical equipment (DME) is defined as “items that can withstand repeated use” and include oxygen equipment, hospital beds, wheelchairs, and other equipment that physicians prescribe for home use. Medical supplies, by contrast, are considered consumable, and are non-durable in nature.

By definition, medical supplies are:

-usually disposable in nature;

-unable to withstand repeated use by more than one individual due to their intended use or construction;

-primarily and customarily used to serve a medical purpose;

-generally not useful to a person in the absence of an illness or injury; and are

-ordered and/or prescribed by a physician.

Medical supplies generally include catheter, ostomy, incontinence, wound care, and diabetic supplies. Medicare classifies enteral nutrition therapy under the prosthetic device benefit. This category also includes such things as devices that replace all or part of a body organ and include leg, arm, back, and neck braces as well as artificial legs, arms, and eyes. In 2007, Medicare spent about $10 billion on medical supplies and equipment.