Which residents qualify?
Residents whose urinary retention or incontinence is documented as permanent (long and indefinite duration), who have active Part B and are not in a covered Part A stay.
What documentation does each claim need?
- A diagnosis and clinical notes supporting permanent retention or incontinence
- An order specifying catheter type and change frequency
- Quantities within LCD limits, with justification for anything above
What CareComply monitors
- Catheter orders without a qualifying diagnosis
- Missing documentation of permanence
- Change frequency above LCD limits
Frequently asked questions
Can a SNF bill Medicare Part B for catheters?
Yes, when the resident’s urinary condition is permanent and documented, the resident has active Part B, and they are not in a covered Part A stay.
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 L33803: Urological 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