Ala. Admin. Code r. 560-X-13-.10

Current through Register Vol. 42, No. 11, August 30, 2024

Section 560-X-13-.10 - Reimbursement And Signatures

(1) Medicaid will reimburse for only those DME, supply, appliance or POP items indicated on the approval letter from Medicaid or its designee.

(2) Reimbursement will be made for purchases or rentals in accordance with the DME Fee Schedule on the Medicaid website.

(3) Request for reimbursement must be submitted on the appropriate claim form. Please refer to Chapter 14, DME, of the Medicaid Provider Manual.

(4) The provider agrees to accept as payment in full the amount paid by Medicaid for covered items.

(a) The provider (or provider's staff) must advise each patient prior to services being rendered when Medicaid payment will not be accepted and the patient will be responsible for the bill.

(b) The fact that Medicaid payment will not be accepted must be recorded in the patient's record. Refer to Rule No. 560-X-1-.07.

(5) Medicaid recipients may be billed for non-covered items.

(6) Medicaid recipients may be billed for items provided by non-enrolled suppliers.

(7) Refer to Rule No. 560-X-1-.18, Provider/Recipient Signature Requirement, for signature requirements. Recipient signatures are required for all DME, supply, appliance and POP claims to validate the billed and reimbursed service was rendered to the recipient. For DME, supply, appliance and POP items that have been delivered, the provider must ensure that the delivery service obtains the recipient's signature or the signature of the recipient's designee. For purposes of this Rule, designee is defined as: "Any person who can sign and accept the delivery on behalf of the recipient." The relationship of the designee should be noted on the delivery slip (i.e. spouse, power of attorney, etc.). The signature of the designee should be legible. If the signature is not legible, the name of the person should be printed on the delivery slip. When payment has been made on claims for which a signature is not available and one of the exceptions in Rule No. 560-X-1-.18 is not applicable, the funds paid to the provider will be recovered.

Ala. Admin. Code r. 560-X-13-.10

Rule effective October 1, 1982. Amended: effective July 9, 1984; June 8, 1985. Amended: Filed October 12, 2001; effective November 16, 2001. Amended: Filed August 11, 2004; effective September 15, 2004. Amended: Filed December 12, 2008; effective January 16, 2009.

Amended by Alabama Administrative Monthly Volume XXXIV, Issue No. 04, January 29, 2016, eff. 2/25/2016.

Author: Kelli Littlejohn Newman, PharmD, Director, Clinical Services

Statutory Authority: State Plan; Attachment 4.19-B, page 5; 42 C.F.R. §§447.50, 447.252; Title XIX, Social Security Act.