Which residents qualify?
Residents with a colostomy, ileostomy, or urostomy who have active Medicare Part B and are not in a covered Part A stay on the date of service.
What documentation does each ostomy claim need?
- An order for the ostomy supplies with type and quantity
- A diagnosis supporting the ostomy
- Quantities within the LCD’s usual monthly maximums, or documented need for more
- Records showing the supplies were used for the resident
What CareComply monitors
- Residents with an ostomy who are not being billed
- Orders missing quantity or frequency
- Usage above the LCD’s usual maximums without supporting notes
- Payer changes that start or stop Part B eligibility
Frequently asked questions
Are ostomy supplies covered by Medicare Part B in a nursing home?
Yes, for residents not in a covered Part A stay. Ostomy supplies fall under the prosthetic device benefit and can be billed by the SNF under its own NPI.
Do we have to change suppliers?
No. CareComply replaces the Part B supply vendor that bills Medicare under its own NPI today. Your facility keeps ordering from its regular supplier, now for all residents, and CareComply bills the Part B–eligible usage under your facility’s NPI.
Does this apply to residents in a Medicare Part A stay?
No. During a covered Part A stay, consolidated billing applies and supplies are part of the Part A payment. Part B supply billing applies to residents who are not in a covered Part A stay and have active Medicare Part B on the date of service.
Sources
- LCD L33828: Ostomy Supplies
- Social Security Act §1861(s): medical and other health services
- CMS Medicare Claims Processing Manual, Pub. 100-04, Chapter 7 (SNF Part B billing)
- Article A55426: Standard Documentation Requirements for All Claims Submitted to DME MACs
Review status: Pending compliance review