July brings with it summer gatherings with friends and family. Many of our patients want to enjoy those gatherings, and to do so, they may need ambulatory equipment to help.
The item that we are looking at this month is the E0100, cane, adjustable/fixed with tips. RemitDATA has provided us with some great information regarding the denials that providers are receiving from Medicare on this product. Overall, claims for the E0100 have a 16.1 percent denial rate. Among the top denial reasons are that the patient has “same or similar” equipment, is in a nursing home or on an inpatient hospital stay at the time of date of service.
These types of denials continue to be a problem for HME companies for many items. So what do we do about it? Let's focus on the denials that occur when a patient is on an inpatient stay, whether in the hospital or a nursing facility.
First, make sure your intake personnel are aware of the delivery timeframes and date of discharge rules that are enforced by Medicare.
Providers who deliver equipment to a patient in a hospital or nursing facility in anticipation of discharge may deliver a DMEPOS item for the purpose of fitting or training the patient in the proper use of the item. This may be done up to two days prior to the patient's anticipated discharge to their home. The supplier must bill the date of service on the claim as the date of discharge, and indicate the place of service (POS) as “12” (patient's home). The item must be for subsequent use in the patient's home. No billing may be made for the item on those days the patient was receiving training or fitting in the hospital or nursing facility.
This means that if the patient is not discharged on the date that was given, then your claim will be denied for an inpatient stay. If you have a large denial percentage due to this issue, then you need to determine the return on investment of having an individual follow up with the facilities to ensure that the patient really is going to be discharged on the date given or if they experienced a relapse requiring an extended stay. According to Medicare, if the patient does not get discharged on the anticipated date, the provider must pick up the equipment, redeliver the item to the patient and bill based on the new discharge date.
Based on anlysis of 6,861 Medicare E0100 claims processed for RemitDATA customers during the fourth quarter of 2010. The average DSO is 67 days. Source: RemitDATA, 866/885-2974 or 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 sarahhanna@bright.net.
