Software
Should the CMN Rule?
Will the Centers for Medicare and Medicaid Services (CMS) ever decide to change the national policy regarding medical necessity documentation? I doubt
Author
Jane W. Bunch
-
-
Software
If the Shoe Does Not Fit, Do Not Deliver
Diabetic shoes and inserts definitely do not the Cinderella story. Providers have always been responsible in supplying the shoes and inserts that are -
Operations
Groups I and II: What Should You Do?
The complicated requirements for Group I and II support surfaces claims involve the “KX” modifier, which must be attached to all such claims. When you attach this modifier, you are stating that all the documentation required by Medicare policy is in the patient’s file. All decubitus care items require a Written Order Prior to Delivery (WOPD), a signed and dated order from the physician prior to delivering the item to a patient. If you fail to obtain a WOPD, the claim will be denied. Even if you obtain the WOPD at a later time, your claim will not be reimbursable under Medicare guidelines. As of April 1, 2003, claims for all items requiring a WOPD were deemed “non-appealable claims.” That means if you attach the... -
Legislation & Regulation
Wake Up to Billing for Sleep Apnea
In 2002, the DMERCs changed coverage policies for CPAPs and supplies to treat those diagnosed with obstructive sleep apnea (OSA). These changes opened the doors to many who could not receive treatment under the old policy. Now, continuous positive airway pressure devices (CPAPs) — HCPCS code E0601 — are covered for patients diagnosed with OSA documented by a facility-based, attended polysomnogram (sleep study) and who meet either of the following criteria: (1) The apnea hypopnea index (AHI) is greater than or equal to 15 events per hour, or (2) The AHI is from five to 14 events per hour with documented symptoms of (a) hypertension, history of stroke or ischemia heart disease; or (b) excessive daytime sleepiness, impaired cognition, mood disorders or insomnia. Correct Documentation... -
Operations
Dare to Soar
The majority of my life is spent on airplanes visiting HME providers throughout the United States, Puerto Rico and the Virgin Islands. As I fly from place to place, I see many similarities among these providers. The primary attribute I always notice and admire is the love and care that they give their patients. Most independent providers started their companies because of a personal experience with a loved one, or the love they have for helping others. Does this change just because a few laws change or reimbursement is cut? Absolutely not! New provisions in the Medicare Prescription Drug, Improvement, and Modernization Act, have made this a time of uncertainty for the home medical equipment industry. But HME providers have experienced many ups and downs...