While submitting any claim the Durable Medical Equipment Medicare Administrative Contractor needs to remember that all bill claims need to be submitted electronically. The DME Claims should not be submitted on paper as per the guidelines of the Administrative Simplification Compliance Act (ASCA). It is also mandatory to obtain a National Provider Identifier (NPI) in addition to registering with the National Supplier Clearinghouse (NSC).
DME Claims Process:
- All suppliers providing covered services for the beneficiaries coming under Medicare need to conform to the claims filing requirement.
- In order to take an assignment of Medicare benefits a supplier needs to be enrolled in the Medicare Participating Supplier Program, or when stipulated by CMS as a mandatory assignment for DME items like home dialysis supplies and equipment.
- There are no charges for preparation and filing of Medicare claim form on behalf of a beneficiary, nor are any charges applicable for completing a Certificate of Medical Necessity (CMN).
- Supplier compliance will be monitored by DME MAC for any claims filing requirement with Medicare.
- Suppliers refusing to submit Medicare claims on behalf of beneficiaries are liable to penal action, which can be as high as $2,000 for each instance.
- A beneficiary may have insurance coverage with companies that pay primary to Medicare. In such cases, a claim may be filed with the primary insurer on behalf of the beneficiary.
- A supplier may choose not to accept any assignment yet ask for payment at the time when service is provided.
- Prosthetic devices, excepting dental devices, come under Part B and are classified as either medical service or health service.
- Also covered under Part B are DME like artificial limbs, eyes, and arms, braces for the neck. A brace can be either a rigid device or a semi-rigid one.
The billing modifier codes should always be included when filling out rental claim forms, in which the commencing and ending dates of the period need to be clearly mentioned. Along with rental forms, the modifier “RR” needs to be quoted against the field 24D, if not the claim will be treated as a purchase, and reimbursement will be processed likewise. Billing can be done only for DME items or services already provided to a patient. Billing for rental has to be for a 30-day period unless it is specifically mentioned as a daily rental, in which case daily billing is permitted.
A patient is allowed to retain a rental DME as long as it is medically required. During the period the rental DME is being used by the patient costs incurred for repairs and maintenance are eligible for reimbursement, for which standard codes and modifiers need to be used along with the claims. However, for the labor charges, a separate repair code needs to be used.
Similarly, if any parts need to be replaced during the purchased DMEs, the replacement parts need to be billed accordingly using a repair code. While submitting a maintenance or repair code, ensure that the code is listed after the procedure code. A claim submitted with a repair code should include a full description of the services that were rendered.
A thorough understanding of the requirements and rules for submitting DME Claims can ensure minimal errors and lesser chances of denials.