CMS has now backed off from the initial date of Dec 31, 2017, and stated that it will work with state Medicaid programs for a different compliance and reimbursement plans. CURES ACT related to Medicaid update was first released in early December. In a view of various physicians and surgeons, CMS has now revised the ruling stating that Medicaid directors will not have an impossible deadline and will look to seek a more collaborative approach related to the compliance. The original letter dated Dec 27, 2017, stated that state Medicaid programs had to notify CMS of their decision of aggregate payment comparisons or alternative approach to compliance. This gave state programs a few days to make an important decision on medical billing. The new guidance issued by CMS on 4th Jan gave in the more flexible structure of guidelines for the state programs to follow. State facilities that decided to change their state Medicaid plan for the DME payment. For this the facilities who pay at or less than Medicare rates for the DME products or the facilities who have amended the state developed fee schedules, all the above facilities must submit a state amendment plan by March 31, 2018.…Read More »
Outsource Durable Medical Equipment (DME) Billing: Do you Really Need It? These will Help You Decide!
Durable Medical Equipment Billing is a $1 billion industry which includes only the income for the providers. Insurance companies/ Medicare (payers) along with outsourcing medical billing companies act as the needed resources for the DME providers. As we see DME providers reaching out to the payers and regulators for more transparent payment model we are here to weight your options. Before we dive into understanding the requirements from you for DME medical billing We need to understand the guidelines laid for a Durable Medical Equipment (DME) Billing. A prescription is required to rent or purchase, as applicable, before it is eligible for coverage. Certain items must be rented and may not be purchased. Certain other items must be rented prior to being converted to purchase in accordance with BCBSNC medical policy. All the bills for the DME should be typed on CMS-1500 (version 08/05) claim form. The entire applicable modifier should be applied after all HCPCS codes. All the bills for maintenance and repair should be first applied before the procedure code. All the equipment’s for which maintenance and repair work is done a claim needs to be submitted. Use E1399 or other miscellaneous HCPCS codes only if no suitable…Read More »