Where Does the Paperwork Go?
Typically, Medicare paperwork to support an SGD claim will be retained by the manufacturer/supplier. Only a cover sheet, known as a HCFA 1500 form is transmitted to the DMERCs, and this will be sent electronically. When the manufacturers/suppliers rely on this method of claims processing, they are asserting to Medicare that they have reviewed the paperwork and that the paperwork is in compliance with Medicare’s coverage guidelines. Medicare does not conduct “prior authorization,” of SGD claims; instead, it reviews claim documentation, through periodic post-payment audits. Manufacturers/suppliers are required to maintain the Medicare claims paperwork and to present them for review upon a Medicare auditor’s request. If the audit reveals flaws in the documentation, Medicare may ask the manufacturer/supplier to re-pay Medicare for the improper payments. For this reason, manufacturers/suppliers have a strong incentive to insist that documentation in support of Medicare claims is complete.
