Garbage In, Garbage Out
Providers are searching for ways to survive the cuts in
reimbursement, streamline their operations and continue to serve
patients as they have in the past. Start with your office and
examine your company's intake processes.
For HME intake, the adage applies: Garbage in, garbage out!
While it is vital that employees are trained in the proper
procedures, intake is more than answering a telephone and putting
information down on paper or entering it into a computer system.
The intake coordinator needs to understand what it takes to ensure
you have all of the information necessary to deliver equipment and
bill the claim in a timely manner.
Remember that it is just as important to educate your intake
personnel as your billing and accounts receivable personnel. The
first impression a referral source is going to have will come from
the person who answers your phone. I have heard an intake
coordinator yell, “Do we sell oxygen? Do they need a
prescription?” Do you think a referral source who hears
something like that will trust your company to set up oxygen for
their patients? I don't think so.
Accept that it may take more than one telephone call with the
initial referral source to obtain all of the necessary
documentation. Go that extra mile and call everyone you can until
you have the information you need. Other health care providers do,
so why don't you?
Review your intake form to make sure it asks for all of the
required information, including:
Patient's full name, as it appears on the insurance card
Patient's delivery address
Patient's “permanent” address. For this, ask
patients where they receive their Medicare checks. This may be
different than the physical delivery address. It will determine to
which DMERC you bill the claim and should decrease your PR-109
denials (billing an inappropriate carrier or the patient is in a
skilled nursing facility).
Patient and emergency contact's telephone number(s) and all
pertinent contact information
The primary insurance policy number and any secondary insurance
information, including telephone numbers for insurance
Treating physician's name, address, telephone and fax, and UPIN
Equipment and/or supplies being ordered for this patient. Make
sure you understand what is being ordered, the quantity and all of
the relevant information for that particular piece of
The date of discharge, if applicable. This is very important for
patients who are in the hospital or an in-patient facility. If you
deliver equipment to a patient in the hospital for training
purposes, you have 48 hours from the date of discharge to bill that
claim using the discharge date.
Date of birth for the patient and, if different, the insured
Social Security number
Diagnosis qualifying the patient for the equipment and/or
supplies ordered. This is vital to ensure you are not delivering
equipment that is not going to be covered. Be very careful with the
ICD-9 coding. Remember, there are numerous coding changes, and the
grace period for providers has been eliminated.
Length of need. This is very important with equipment that can
be rented toward the purchase price. The National Supplier
Clearinghouse 21 Supplier Standards state that a provider must give
the patient the right to rent or purchase equipment in the
“IR” category (inexpensive or routinely purchased items
in the fee schedule). If the length of need does not constitute a
purchase but you bill it as a purchase, you will owe the DMERC back
for the remainder of that reimbursement. For example, if a bedside
commode length of need is two months, it does not meet the
guidelines as a purchase.
Other required information should be on separate intake forms
for each category of equipment or supplies to ensure that the
correct questions are asked. If you specialize in any particular
categories, then add those questions necessary to the intake
Dusting off your intake process can be the first Band-Aid in
your survival kit for doing business in the new reimbursement
Jane Bunch is CEO of Kennesaw, Ga.-based JB&CS. A
reimbursement specialist, Bunch delivers educational seminars
worldwide, helps develop corporate compliance plans, and serves as
a consultant for fraud and abuse cases. She can be reached at
678/445-1221 or via e-mail at target="_blank">BILLHME@aol.com.
comments powered by Disqus