Month: February 2017

  • DME Billing
    how-to-avoid-medicare-audits-for-your-dme-practice

    How to avoid Medicare Audits for your DME practice?

    Consciously or unconsciously, physicians or their staff may unknowingly be active or passive participants in Medicare fraud, waste, and abuse. Recent figures on the Medicaid program illustrate the scale of the problem. According to the Centers for Medicare & Medicaid Services (CMS), the cost of medical coverage in fiscal year (FY) 2015 was $547.7 billion. The Federal government paid $341.6 billion of that amount. Improper payments were cited as one of the reasons, and it “includes those made for treatments or services that were not covered by program rules, that were not medically necessary, or that were billed for but never provided.” The owner of a Texas durable medical equipment (DME) company, his wife, and other employees admitted to participating in a fraud scheme that involved recruiting beneficiaries to give up their Medicare or Medicaid numbers, misappropriating physicians’ medical identifiers, submitting fraudulent billings, and submitting up to $11 million in false claims, representing about 85 percent of their income. In many instances, the physicians did not see the patients, and beneficiaries never received the items ordered in their names. In 2013, the owner was sentenced to 12 years in prison and ordered to pay $6.1 million in restitution So here’s…

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  • DME Billing
    get-error-free-charge-entry-for-dme-billing

    Get Error Free Charge entry for DME Billing

    The DME coding and billing is a very complicated process and involves not just expertise in the coding and billing of DME services, but also qualities like patience and attentiveness to details. To ensure an efficient and effective Revenue Cycle Management process, the charge entry process needs focus in your DME Billing process. The charge entry process is the most crucial juncture in the billing cycle – where the claims are created. The significant details required to get correct to make this process seamless are – fact sheet of the patient, physician details, information about the insurance coverage of the patient and the billing information. It is the most vital process of any medical billing workflow, including the DME billing management process. To have an error-free charge entry for the DME billing & claims process, diligently follow the below steps Keying in Medical billing information: Entering the billing information of the patient is an important step in the charge processing stage. Having a trained staff to enter the billing details of the patient, as it includes vital information such as the name of the medical provider, the medical service rendered and the date of the patient’s visit is essential. And…

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  • DME Billing
    5- ways-to-ensure-accurate-billing-for-durable-medical-equipment-orders

    5 ways to ensure accurate billing for durable medical equipment orders

    DME billing and coding is a very complex system and involves a certain level of expertise. Besides expertise, awareness and knowledge about the constantly changing coding system by CMS help ensure accurate billing that helps reap rewards. Here are a few ways that can help ensure accurate billing for DME services: Awareness of kinds and types of modifiers: Modifiers are known to influence fee schedules and help fix prices paid for DME. Moreover, the reimbursements for rental and purchase are not always the same. Each modifier should be studied in detailed, understood what they mean and when each can be used appropriately. Coding when using components and accessories: especially wheelchairs carry specific codes for components and accessories of wheelchairs which need to be employed appropriately Terminology: It is imperative to know how and when specific terms can be employed to ensure accurate billing. For example, a power wheelchair with attachments like a basket or headlights may not be classified as “custom” and can only be termed a wheelchair with extra options. Here, HCPCS is appropriate for the base and the extra components can be billed under a separate heading. Operational Protocols: To ensure accurate billing, the need to establish operational…

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  • DME Billing
    5-most-common-errors-with-dme-billing

    5 most common errors with DME billing

    DME billing is not very straightforward, and when healthcare providers integrate it to increase their revenues, the complexities increase. Medicare is known to lose more money to wasteful spending than any other program government-wide, with more than $60 billion in erroneous billing each year The most common errors with DME billing that can trip anyone involved in DME billing are listed below. Verification of Patient Data: More often than not, DME billing claims have been denied because of a small error either by the Insurance provider or the CMS because of the error in names or the way the forms have been filled in. Coding errors: When the provider submits medical documentation indicating a different code other than the one billed  &/or service was provided by someone other than the billing provider, the billed service was unbundled, or a beneficiary was discharged at a place other than the one coded on the claim Usage of Modifiers: More often than not, wrongly used modifiers for DME billing can lead to claims being denied and/or rejected. Even a misaligned code can cause the claim to be denied Medical Necessity: when the documentation shows that the services billed were not medically necessary according…

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