Improper Payment Reasons Durable Medical Equipment (DME) suppliers of surgical dressings and physicians submit claims for surgical dressings and CMS covers it under the surgical dressings benefit i.e., SSA Section 1861[s][5]. CMS recently published Medicare Fee-for-Service (FFS) improper payment rate for surgical dressings for the 2020 reporting period. For this reporting period, the improper payment […]
The A/B Medicare Administrative Contractors (A/B MACs), and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) send to providers, physicians, and suppliers, as a companion to claim payments, a notice of payment, referred to as the Remittance Advice (RA). RAs explain the payment and any adjustment(s) made during claim adjudication. For each claim or line […]
Home blood glucose monitors (BGMs) and continuous glucose monitors (CGMs) are covered under the Durable Medical Equipment (DME) benefit. In order for a beneficiary’s DME to be eligible for reimbursement, the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination (LCD) must be met. In addition, there are specific statutory payment […]
When one has to manage something as important as the claims submission for your optometry practice, many can be defensive of the process as it directly connects with their revenue cycle. As a healthcare service provider and a facility owner, it’s great to keep an eye on the processes that are making your practice earn […]
Medical billing and coding for general surgery are not as simple as you think. Besides being educated in procedures ranging from hernia repair to a bladder surgery, the billing and coding staff need to be knowledgeable in the proper use of the global surgical package, modifiers for surgeon roles and same-day procedures, and citations for […]
Documentation is a critical undertaking in any specialty medical facility. It is an essential tool for conveying essential clinical information about each patient’s diagnosis, treatment, and results and for communication between physicians, medical billers and coders, and the payers. Doctors and their team of medical billers must efficiently respond to the questions that payers are […]
Durable Medical Equipment (DME) offer therapeutic benefits to patients who need its assistance owing to certain medical conditions. The items may either be rented or purchased, depending on a number of factors. These, though have set rules for opting either. The rental period for the item is generally 13 months after which the patient may […]
Durable Medical Equipment (DME) like Crutches, canes, special cots, wheelchairs, slings, electrodes, etc are being frequently prescribed by physicians to help out people who have suffered injuries. However, there are several models and types available with a host of features. It is important that an injured person gets the correct equipment at an affordable price. […]
With health systems, medical centers, hospitals, and physician practices facing dismally low reimbursement figures and increasing risk and margin pressures breathing down their necks improving revenue are of paramount importance. Revenue cycle management experts are advocating improvements and the efficient management of accounts receivable as well as charge capture, coding, processing of claims, secondary billing, […]
Billing is a vital aspect of any business, and healthcare is no exception. Millions of dollars can be lost if pitfalls are not understood and are repeated time and again in the billing and coding of medical practices, especially for ‘Durable Medical Equipment (DME).’ This equipment typically serves a medical purpose and is used routinely. […]