Adopting Relaxed Respiratory Supply requirements in HDMS


One aspect of the CMS Final Rule publication indicates that respiratory equipment can be dispensed without qualifying criteria. If you are a Provider dispensing life-saving equipment to COVID-19 patients, here is the information you need once your work orders become revenue.


Your Medicare Processor might not be ready...

As of Wednesday, April 22nd DME MAC's like NGS & Noridian indicate that they are awaiting direction from CMS related to processing claims where prescription & face to face information may be absent. Currently, DME MAC's automated claims adjudication processes look for that information in various loops & segments spread throughout your claim files; and understandably changing that processing is a large undertaking. 

Many local & national HME Provider associations encourage Providers to hold their COVID-19 related equipment & supply claims at this time. 


Be Aware: It is possible that submitting oxygen/vent claims without previously required information may cause your entire Medicare Claim file (ANSI 837) to be rejected from the EDI Gateway. 


Hold Options in HDMS...


Item Hold: set at the bill code level, this will automatically hold the item when it’s confirmed and will not allow it to turn over additional rental months.  This will affect revenue.

  • You could also implement this process by creating a Product Master Question with a 525 functional indicator that while hold the items on the order when answered Yes.
  • To start/resume billing, staff will use the Item Hold Report in order to release each order via Existing Orders.

Homework: review the HDMS Wiki Bill Code Table entry or Product Master Table Wiki entry to learn more about implementing Item Holds.


Automatic Claim Hold: this hold must be applied in the existing order per line item, after the order has been confirmed. This will allow rental claims for respiratory equipment to continue generating revenue each month, but will put them on claim hold of your choosing so that they are not gathered for EDI Transmission.

  • To start/resume billing, staff will use the Claim Hold Report to release claims from hold via the Claim Maintenance screen. These claims will also be visible on the Unbillable Revenue Center.

Homework: review the HDMS Wiki Existing Order entry to learn more about adopting this process.