Downsize Those DSOs

HCPCS Code E0470
(Respiratory assist device, bi-level pressure capability, without backup rate feature)

Average Medicare DSO
61 days

The high DSO for E0470 is attributed to the fact that this code requires additional documentation from both the physician and patient before a provider can file a claim for rentals in the fourth and consecutive months. By placing the KX modifier on the claim for the fourth month, the supplier indicates that he has documentation proving the patient meets the “initial coverage” criteria along with additional documentation from the physician and patient. If the claim is sent before the receipt of the additional documentation, the KX modifier should not be added.

No sooner than the 61st day after therapy begins, the supplier should receive a statement signed and dated by the treating physician declaring that the patient is compliant in using the device (an average of four hours per 24-hour period) and that the patient is benefiting from the use of the E0470. The next document that must be obtained is a statement completed, signed and dated by the beneficiary, a family member or caregiver. It may not be completed by the supplier. The beneficiary statement must document that the E0470 is currently being used for four or more hours per 24-hour period, that it has been used for at least two months at the time of the statement’s completion, that the beneficiary plans to continue using the device in the future and that the person completing the statement is not the supplier. The Durable Medical Equipment Regional Carriers (soon to be Medicare Administrative Contractors) have a suggested form that you can find on their Web sites in the medical policy sections. Just like the physician statement, the statement from the beneficiary should not be completed any sooner than the 61st day after the initiation of therapy.

Physicians and patients need to be reminded to send the documentation back to the supplier in a timely manner. Many suppliers use the expiration field on their billing systems so that the fourth month’s claim and subsequent claims don’t bill until the statements have been returned. If you don’t track these documents for their return, your claims for E0470 will remain unbilled and in accounts receivable.

Data represents a categorized and weighted analysis of approximately 981,000 Medicare paid claim lines adjudicated by the four DMERCs between Jan. 1, 2006, and Jan. 31, 2006, and processed for RemitDATA customers. Figures reflect the average number of days elapsed from date of service to Medicare check issue date. Source: RemitDATA, 866/885-2974, www.remitdata.com

Sarah Hanna is a reimbursement consultant and vice president of ECS Billing & Consulting, Tiffin, Ohio. She has conducted numerous training seminars and personal client consultations on proper billing protocols, Medicare coverage guidelines and billing office procedures for accounts receivable collections. Hanna can be contacted at 419/448-5332 or [email protected].