durable medical equipment billing companies
-
DME Billing Services
Prior Authorization Process for DME during COVID-19 – Provider Burden Relief FAQs
The importance of medical review activities to CMS’ program integrity efforts, CMS will stop exercising enforcement discretion for the Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items beginning on August 3, 2020, regardless of the status of the public health emergency. Is CMS suspending most Medicare Fee-For-Service (FFS) medical review during the Public Health Emergency (PHE) for the COVID-19 pandemic? Yes, CMS had suspended most Medicare Fee-For-Service medical review during the COVID-19 period. This includes: Pre-payment medical review conducted by MACs Post-Payment reviews conducted by MACs Supplemental Medical Review Contractor (SMRC) Reviews Recovery Audit Contractor (RAC) No additional documentation request will be placed during the COVID-19 emergency period. Targeted probe and Educate reviews that are in process will be suspended and claims will be paid. All current post-payment MAC, SMRC, and RAC reviews will be suspended and released from review. This suspension of review activity is for the duration of the public emergency period only. However, CMS reserve the right to conduct medical review during or after a pandemic situation if there is an indication of potential fraud. Is CMS waiving signature requirements on proof of delivery slips in response to the COVID-19 pandemic,…
Read More » -
DME Billing Services
DME Supplies for Children with Disabilities
There might be a need for medical equipment or supplies for children with disabilities or having special health care needs. Once you identify your child’s needs then, you will be thinking about the different options as well as the ways to pay for durable medical equipment. However, insurance is one of the solutions for your problem as both Medicaid and other health insurance which is often cover some or all of the costs for these medically necessary items. Following tips are important to walk through for insurance system including Medicaid: Durable Medical Equipment (DME) and Supplies for Children DME is a kind of medical equipment, which is generally used for a longer period of time. Majority of the durable medical equipment anticipated to last for more than three years. Some of the DME’s are as follows: Hospital beds Hearing aids An augmentative communication device especially for children who are unable to speak or possessing some sort of speaking disability Manual and power wheelchairs Oxygen equipment Many children who utilize DME also need medical supplies. These supplies are utilized for a short period (sometimes utilized only once) and then disposed of. Many of these supplies needed on daily as well as…
Read More » -
DME Billing Services
DME Supplies: CMS Flexibilities to Fight COVID-19
From the beginning of the outbreak, the government has issued an uncommon range of temporary regulatory exemption as well as new rules and regulations in order to solidify the American healthcare system with the utmost flexibility to fight with the Novel Coronavirus (COVID-19) pandemic. These temporary changes in the guidelines will apply all over the United States healthcare system during the emergency period of the pandemic. Major goals of these actions are as follows: To make sure health systems and local hospitals have the capability to manage COVID-19 patients’ upsurge via temporary expansion site, which is known as CMS Hospital Without Walls To make the hiring process simple, which means there will be no barriers for nurses, physicians, and other clinicians to be hired form different states or communities. This leads to the expansion of healthcare workforce at a faster pace Penetration of telehealth in Medicare Increase in-place testing to permit for several testing in a community-based setting or at home Minimalistic paperwork; bring Patients Over Paperwork in order to offer temporary relief from different paperwork, therefore health care facilities, providers, Medicare Advantage and Part D plans, and States can aim at offering required care to Medicare and Medicaid beneficiaries impressed…
Read More » -
DME Billing Services
How to order DMEPOS items correctly?
As per the Medicare Program Integrity Manual, Chapter 5 (Items and Services Having Special DME Review Considerations), before you dispense any DMEPOS item to a beneficiary, you need to have an order from the treating physician. Please note that this article is intended for suppliers billing Durable Medical Equipment (DME) MACs for Durable Medical Equipment Prosthetics, Orthotics Supplies (DMEPOS) provided to Medicare beneficiaries. Verbal or preliminary written orders: Suppliers may dispense most items of DMEPOS based on a verbal order or a preliminary written order from the treating physician/practitioner. Detailed written orders required before claim submission: A detailed written order may be a photocopy, facsimile image, electronic, or pen-and-ink original document. For all items, the supplier shall have a detailed written order prior to submitting a claim. It needs to have a description of the item to include all options or additional features that will be separately billed, or that will require an upgraded code. The description can be either a general description (for example, “wheelchair or hospital bed”), a brand name/model number, and HCPCS code or HCPCS code narrative. It must include the beneficiary name, the date of the order, and the physician/practitioner signature. If it is for a drug provided…
Read More » -
DME Billing Services
Physician Liability for DMEPOS Medical Necessity
The Medicare program only pays for health care services that are medically necessary. In determining what services are medically necessary, Medicare primarily relies on the professional judgment of the beneficiary’s treating physician, since he or she knows the patient’s history and makes critical decisions, such as admitting the patient to the hospital; ordering tests, drugs, and treatments; and determining the length of treatment. In other words, the physician has a key role in determining both the medical need for, and utilization of, many health care services, including those furnished and billed by other providers and suppliers. Physicians are required to certify to the medical necessity for any service for which they submit bills to the Medicare program. Physicians are involved in attesting to medical necessity when ordering services or supplies that must be billed and provided by an independent supplier or provider. Medicare requires physicians to certify to the medical necessity for many of these items and services through prescriptions, orders, or, in certain specific circumstances, Certificates of Medical Necessity (CMNs). These documentation requirements substantiate that the physician has reviewed the patient’s condition and has determined that services or supplies are medically necessary. Two areas where the documentation of medical…
Read More » -
DME Billing Services
How to become DME Supplier for Medicare?
The regulation of businesses providing Durable Medical Equipment (DME) or Home Medical Equipment (HME) is dependent upon the types of equipment, as well as the jurisdiction. Since the term DME covers a wide array of devices, from crutches to catheters to wheelchairs to blood glucose monitors, it may not always be clear for businesses whether they must be licensed in a particular state. Furthermore, additional permitting may be required for certain types of equipment (e.g., a Pharmacy License for oxygen-related devices). DME suppliers are governed by stringent federal and state laws, particularly those that participate in the Medicare/Medicaid program. Initially, if a license is determined to be required, a DME company must obtain an “in-state” or a “resident” license. This generally requires an extensive application, varying fees, proof of insurance, and an inspection, which is usually scheduled upon approval of the application. If the company wishes to expand into another state, it must obtain an “out-of-state” or a “non-resident” license in that state. This process is more of the same, but also may require verification that the business currently holds a resident license (or proof that a license is not required) in the home state. Medical practitioners and medical service…
Read More » -
Common Modifiers for DME
When billing for durable medical equipment (DME), use the appropriate HCPCS code and modifier(s) to describe the items being billed. Also, include an ICD-9/ICD-10 diagnosis code indicating the medical condition for which the item has been prescribed. In addition to an appropriate HCPCS code for the DME item, many HCPCS codes require a modifier. The modifiers are used to provide more information about the item. For example, the modifier may tell HMSA that an item is new, used, or rented on a capped basis. For capped rentals, modifiers distinguish which month’s rental is being billed. If these modifiers are used incorrectly or missing, the claim may be denied. To expedite processing of your claims, please indicate the first-month rental by including the appropriate modifier code, and bill your claims in sequential order. Inexpensive or Routinely Purchased DME Inexpensive DME-This category is defined as equipment whose purchase price does not exceed $150. Routinely Purchased-This category consists of equipment that is purchased at least 75% of the time. Payment for this type of equipment is for rental or lump-sum purchase. The total payment may not exceed the actual charge or the fee for purchase. Common modifiers used in this category are: RR…
Read More »