Refusal of Suppliers to File Medicare Claims Is Illegal

I have been advising lymphedema patients to appeal every denial of reimbursement for the compression bandages and garments used in the treatment of their lymphedema. Some suppliers do not file claims, claiming that these items are not covered by Medicare.

This refusal is illegal since these items have been found to meet the coverage criteria for "prosthetic devices" by several Administrative Law Judges, and the decision that they are not covered is not a decision that a supplier can make. CMS has recently published a clarification of the rule that requires Medicare-enrolled Suppliers to file a claim on behalf of a Beneficiary. This educational article can be downloaded as follows:

Mandatory Claims Submission and its Enforcement http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0908.pdf

The Social Security Act (Section 1848(g)(4)) requires that claims be submitted for all Medicare patients for services rendered on or after September 1, 1990. This requirement applies to all physicians and suppliers who provide covered services to Medicare beneficiaries, and the requirement to submit Medicare claims does not mean physicians or suppliers must accept assignment.

Compliance to mandatory claim filing requirements is monitored by CMS, and violations of the requirement may be subject to a civil monetary penalty of up to $2,000 for each violation, a 10 percent reduction of a physician’s/supplier’s payment once the physician/supplier is eventually brought back into compliance, and/or Medicare program exclusion. Medicare beneficiaries may not be charged for preparing or filing a Medicare claim.

For the official requirements, see the following:

Social Security Act (Section 1848(g)(4)(A); "Physician Submission of Claims" at http://www.ssa.gov/OP_Home/ssact/title18/1848.htm on the Internet.

Requirement to file claims – The Medicare Claims Processing Manual, Chapter 1, Section 70.8.8: http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf on the CMS website.

Robert Weiss
Lymphedema Patient Advocate

Gloves and Hygiene

With everybody telling us to wash our hands frequently, I'm looking for solutions to the problem of how to keep my gloves clean throughout the day. I've written to a number of garment makers, but they're pretty much clueless (some are surprised nobody's asked them that before!) Here's what I've discovered so far:

1. Wearing plastic gloves over my compression gloves makes my hands sweat instantly and soaks my compression gloves in a matter of minutes -- miserably uncomfortable, and not especially helpful from the standpoint of fungal infections either.
2. Alcohol applications like Purell will ruin the fabric of our compression garments.
3. Dry cleansers like dry shampoo give your hair a lift by cutting down on the grease, but they don't actually clean anything.
4. Dry antiseptics have nasty things in them like boric acid that you wouldn't want on your hands.
5. I can take my gloves off and wash my hands a lot when I'm doing anything messy or unhygienic (even though with compression garments that's not very easy), but that doesn't prevent them from collecting germs and crud from doorknobs or other innocent-looking surfaces.
6. I can (and do) just wash my gloves throughout the day while they're still on my hands, using hot water and Ivory or Dove hand soap. I dry them on a thick towel just like I would my hands alone, but of course they're still damp. I can't handle books or papers until they dry (here in the desert that only takes 15 or 20 minutes). But if it's cold (think, air conditioning) that doesn't work, because my hands freeze. And if I lived somewhere humid it wouldn't be a good idea to leave my hands damp for long enough for it to dry out.
7. And here's a tip from one of the garment makers: For goodness sake wash the things every day! – Binney

• As a pianist who plays with gloves occasionally, you might find these good for over-gloves - you could wear them over your gloves in public: http://www.gallawayb2b.com/Products/Inspection-Gloves They are a stretchy (not too stretchy) nylon...and come in cotton too. I found that the cotton lose their shape, however, they absorb dirt and oils better and thus are a bit more tactile. The nylon ones are slippery. I have a typical woman's size hand and I ordered woman's which I wear alone. The nylon ones wash great in the laundry (with bleach even). The cotton ones shrink. you could always get a man's size. I find them pretty easy to work with. I can type and play the piano while wearing them. I wear the nylon ones all the time in the winter. I found that you can turn the gloves inside out and trim off the extra fabric along the finger seams for extra dexterity. – apple
• If you are dealing with a situation where you know your compression gloves will be in water or in a situation where they will get very wet, be sure to wear either sugical gloves, dishwashing or rubber garden gloves over your compression gloves. We don't want our compression gloves to stay wet long enough to develop a breeding ground for fungus. For regular protection from germs and dirt, I prefer the stretch nylon gloves mentioned by Apple at Stretch Nylon Inspectors Gloves ~ Gallawayb2b.com. They fit nicely over compression gloves. I order them by the dozen. I keep several pair with me in my handbag, so I can put a fresh pair on frequently, then wash them all at night and start my day off with several clean pairs of nylon gloves and surgical gloves in my bag. It has made a real difference in my feeling safer at keeping germs and dirt at bay. You can also easily dye the nylon gloves to match your various outfits--OneBadBoob
• One thing I do in public restrooms is grab a paper towel before I turn off the water, use the towel to turn off the water so I'm not touching the dirty handle with my clean hand. I also use a towel to open the door when I leave. Of course, then I'm out in the world without a clean paper towel, and I do touch things, but I also have developed some little tricks to avoid getting germs on my hands: I push the elevator button with my elbow, and I use the hem of my shirt or my sleeve (if I'm wearing long sleeves) to open doors or flip switches. – aprilintexas
• When I have to use a keyboard that is used by others, I wipe it down with an anti-septic wipe. Phones too. – Kira
• On that note, don't use the 'community pen' at businesses when writing checks or noting use of your check card in your register or signing in on the guest register at businesses. – lvtwoqlt
• Also, cough and sneeze into your elbow or tissue, not your hands. – leaf