Software
What Code Shall I Use?
If you do not adapt well to change, then the DME industry is not for you. It is vital that owners, managers and employees download Medicare updates on
Author
Jane Bunch
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Software
Let’s Get Lean and Mean
With the growing concern regarding reimbursement cuts, pharmacy changes, competitive bidding and the other doom-and-gloom news you hear, I say let's get -
Legislation & Regulation
Are You Prepared for a Motorized Mobility Audit?
If the DMERCs were to audit your K0011s (motorized wheelchair with programmable controls) and/or your E1230s (power operated vehicles/scooters), would you survive the audit? As part of the government’s 10-point plan to curb fraud and abuse in this market, the local medical review policy (LMRP) was reviewed carefully, giving consistency on how the DMERCs will audit and reimburse for these items. Not only will there be pre-payment reviews, there will be numerous post-payment reviews to verify that the provider should have been paid based on the documentation obtained. For K0011s and E1230s, Medicare will apply the national policy on old as well as current dates of service. The policy states that a “patient must be bed- or chair-confined without the use of a wheelchair, and... -
CMS/Medicare
Happy New Year! It’s Deductible Time!
It’s our favorite time of year, the time when we pay close attention to the “Deduct” column on our Medicare Explanations of Benefits (EOBs). Medicare applies a $100 deductible to each beneficiary in the New Year. The question I am asked the most by home medical equipment providers is, “How do I reduce my exposure to Medicare’s deductibles beginning Jan. 1?” The second question I am asked is, “Do I have to collect this money from the beneficiary?” Let’s review these two questions. There is no true science that can completely alleviate the reduction of revenue your company will experience from deductibles, but there are ways to reduce your exposure. Medicare will apply the deductible toward the first claims they receive each year for each... -
Legislation & Regulation
Ready Set Hold It!
How many times were we told that the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction set would be implemented on Oct. 16, 2003? Well, in an effort to allow providers to turn the switch and bill the new ANSI format, it was found that many of our trading partners, for whatever reason, were not ready for the event. So, the Centers for Medicare and Medicaid Services has activated a contingency plan that grants an extension to that well-publicized deadline. This does not mean that HIPAA is going away. Providers must show a good faith effort in complying with the new electronic guidelines for claims submission. Have you developed a plan? Is your software vendor ready? Are you electronically transmitting now under the ANSI... -
You’ve (Probably) Got Mail
Have You Received Your Audit Request? If you have not received an audit request from AdvanceMed already, it is likely that you will. AdvanceMed is an -
Operations
It Adds Up
Have you begun transmitting your 2003 dates of service yet? If so, watch those EOBs [explanations of benefits] fly in — with $100 consistently in the “deduct” column. Private-insurance deductibles can — and will — range from $100 to $500, and more. Let me share with you my experience with reducing the amount of revenue lost to deductibles. About six years ago, I conducted an internal test to see what percentage of deductibles would be reduced if I waited to transmit dates of service at a later date. I set my electronic claims submission date for Feb. 15, instead of my regular Jan. 8 transmission date. As a result, my rate of reducing deductibles was 62 percent across the board. What a difference six weeks...