Make Sure Enteral Claims Are Complete

The HCPC B4150 is one of the most common enteral nutrients billed to Medicare. But a review of these claims by the Jurisdiction C DME MAC (Cigna Government Services) found errors in the patient medical record regarding proof of delivery, detailed written orders, medical necessity and the DIF (DME MAC information form).

Make sure you understand where such errors might be occurring within your company as well as those outside so that employees can learn from mistakes to ensure future compliance.

Enteral nutrients and supplies may be delivered based on a preliminary dispensing order (written, fax or verbal). You are required to include written documentation of this order in the beneficiary’s file, and it must contain the beneficiary’s and physician’s names, a description of the item(s) and the date of the order.

Enteral supplies and nutrients cannot be billed to Medicare prior to obtaining a detailed written order, which must contain: beneficiary’s name; description or name of the nutrient to be administered; method of administration (syringe, gravity or pump); rate/frequency of administration; list of all additional items to be dispensed and billed; length of need; the treating physician’s signature (stamped signatures are not acceptable); the physician’s personally entered signature date; and the start date of the order (only required if the start date is different than the signature date).

When a nurse documents a verbal or telephone order from a physician, this order may serve as a preliminary dispensing order but it is not a valid detailed written order until the physician personally co-signs and dates that order and it contains the required elements listed.

Due to the requirement of the DIF for enteral nutrition, don’t lose sight of the fact that you are still required to have a compliant detailed written order on file in addition to the DIF. Providers billing for enteral nutrition are required to complete, sign and date the DIF for enteral and parenteral nutrition prior to billing Medicare. And remember that DIFs are OMB-approved forms that you cannot alter by adding a company logo or a line for physicians to sign, etc.

For claims adjudicated for Medicare, Medicaid and commercial insurance between June 1-30, 2009, and processed for RemitDATA customers, denial of B4150 claims averaged 14.5%, 22.1% and 11.3% respectively. DSO for commercial insurance was 64 days and 86 days for Medicare. Source: RemitDATA, 866/885-2974, www.remitdata.com

Read more Working Down Denials columns

Sarah Hanna is a reimbursement consultant and vice president of ECS Billing & Consulting, Tiffin, Ohio, and specializes in proper billing protocols, Medicare coverage guidelines and billing office procedures. You can reach her at 419/448-5332 or [email protected].