ICD10 and CPT codes

  • DME Billing Services
    DME Prior Authorization Programs - GAO

    DME Prior Authorization Programs – GAO

    According to the analysis of GAO, CMS’s prior authorization programs for durable medical equipment (DME) created an estimated $1.9 billion in Medicare savings. CMS’s prior authorization programs for durable medical equipment (DME) and mobility devices have controlled unnecessary spending, according to a new Government Accountability Office (GAO) report. This was created between $1.1 and $1.9 billion in Medicare savings from 2012 to 2017. Prior authorization is a payment approach used by private insurers that generally requires health care providers and suppliers to first demonstrate compliance with coverage and payment rules before certain items or services are provided to patients, rather than after the items or services have been provided. This approach may be used to reduce expenditures, unnecessary utilization, and improper payments. The Centers for Medicare & Medicaid Services (CMS) has begun using prior authorization in Medicare through a series of fixed-length demonstrations designed to measure their effectiveness and one permanent program. According to GAO’s analyses, expenditures decreased for items and services subject to a demonstration. GAO’s analyses of actual expenditures and estimated expenditures in the absence of the demonstrations found that estimated savings from all demonstrations through March 2017 could be as high as about $1.1 to $1.9 billion.…

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  • DME Billing Services
    CY 2020 Update for Durable Medical Equipment

    CY 2020 Update for Durable Medical Equipment

    CMS has revised previous updates of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule on January 3, 2020, to reflect an updated Change request (CR) that corrected the CY 2020 maintenance and servicing fee for certain oxygen equipment to $73.02 in the CR’ s business requirement 11570.9. The transmittal number, CR release date, and link to the transmittal also changed. All other information remains the same. These changes are intended for providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items or services paid under the DMEPOS fee schedule provided to Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) updates the DMEPOS fee schedule on an annual basis in accordance with statute and regulations. For CY 2020, the following applicable Fee Schedule Adjustment Methodologies and fee schedule amounts reflect the area in which the items and services are furnished. Fee Schedule Amounts for Areas within the Contiguous United States Claims with DOS Jan 1, 2019 – Dec 31, 2020 The adjusted fee schedule amounts for items furnished in non-competitively bid rural areas are a blend of 50 percent of the adjusted fee schedule amount and…

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  • DME Billing Services
    Streamline your DME Billing with MBC

    Streamline your DME Billing with MBC

    All the healthcare providers are searching for a streamlined DME billing operation team that may handle their DME billing process without much hassle. According to MarketWatch, the worldwide marketplace for Durable Medical Equipment (DME) is predicted to achieve up to USD 246.6 billion by the year 2026. This rise is predicted because of the advantages that DME products like a wheelchair, nebulizer, canes, crutches, walkers, etc. wear peoples. except for making patient’s life easy, the DME products also help these patients live a life without much pain making them independent. Besides the above benefits, technological advancement within the DME medical equipment is additionally other reason for the increase of the DME market and in fact, the rising geriatric population. As old people are more prone to chronic diseases, requiring extended care that involves more of the DME products for leaving a simple life. As per the report, the worldwide DME market is fragmented supported the tip user, region, and device type. With reference to device type, the market is further divided into therapeutic and monitoring devices, medical furniture and loo safety devices, and private mobility devices. Sub-segments of the therapeutic and monitoring devices market include nebulizers, infusion pumps, oxygen equipment,…

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  • DME Billing Services
    Prior Authorization Process for DME during COVID-19 - Provider Burden Relief FAQs

    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,…

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  • DME Billing Services
    DME Supplies for Children with Disabilities

    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…

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  • DME Billing Services
    DME Supplies: CMS Flexibilities to Fight COVID-19

    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…

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  • DME Billing Services
    How to order DMEPOS items correctly?

    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…

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