Billing & Reimbursement

No matter how careful, Medicare claim mistakes will happen. When they do, your claim may not be able to be processed by the DME MAC. However, The van Halem Group is here to help! In a recent article, The van Halem Group provided examples of minor errors and omissions that can occur with claims, and they also remind providers that they can request a reopening for minor errors or omissions either by telephone or in writing. Whether or not they should be requested via phone or in writing is

On January, 1 2020, CMS made it effective that only one type of order is needed for DMEPOS claims, in an effort to help reduce supplier and provider burden. As such, the preliminary/dispensing order, Detailed Written Order (DWO), Five Element Order (5EO)/Written Order Prior to Delivery (WOPD), Seven Element Order (7EO), and Detailed Product Description (DPD) are no longer needed for DMEPOS and have been replaced by a Standard Written Order (SWO). However, with this publication came many questions

In a recent update from Ronda Buhrmester with VGM Government, the Standard Documentation Requirements (SDR) has been updated. These updates went into effect on January 1, 2020.  There are now two types of orders and 1 new acronym, standard written order (SWO) and Written Order Prior to Delivery (WOPD). As noted in the SDR, a SWO must be communicated to the supplier prior to claim submission. For certain items of DMEPOS, a written order is required prior to delivery (WOPD) of the item(s)

New DMEPOS HCPCS codes have been added to the HCPCS file effective January 1, 2020.  One of the new codes that was added is L8033 PO- Nipple prosthesis, custom fabricated, reusable, any material, any type, each. Until national Medicare coverage and payment guidelines have been established for these new codes, there are no fees added to the DMEPOS fee schedule file for new HCPCS codes effective January 1, 2020. The Medicare coverage and payment determinations for these items are made

As the industry is in the midst of open enrollment, VGM's Ronda Buhrmester reminds Medicare suppliers that they have until December 31, 2019 to change their enrollment status to non-participating. In a recent VGM Government update, Ronda explains that being enrolled as a participating supplier means that the supplier accepts the Medicare fee schedule and will bill all claims on an assigned basis. Being enrolled as a non-participating supplier, however, means there are options for the

When it comes to selling a business, many owners wonder if they can still get audited. If they do get audited, they then wonder if they have personal liability. In Jeffrey S. Baird's recent article in Medtrade, he provides insight into what could happen in different scenarios related to selling a business. Click here to read the full article from Medtrade.

A few weeks ago, Essentially Women posted a blog about billing non-assigned, written by Jeff Baird, JD, from Brown & Fortunato, PC. Jeff recently posted a follow-up to his original article, with additional information.  For the last four decades, DME suppliers have primarily provided DME on an assigned basis. Medicare paid the suppliers directly and the patients only had to pay their copayments and deductibles. Until approximately 2010, this worked out for DME suppliers. Reimbursement was

In today’s climate of competitive bidding and low reimbursement, it is challenging for suppliers to rely entirely on the assignment model, where Medicare pays the DME supplier directly and the patients are only obligated to pay their copayments and deductibles. Jeffrey S. Baird explains that the industry is witnessing an increasing number of DME suppliers that are (i) electing to be non-participating and billing non-assigned and (ii) selling products to patients for cash.  Continue

The Editorial Advisory Board of HME Business recently shared their insights into what key trends they think providers should be incorporating into their strategic business planning for at least the near term. They believe that providers must diversify and learn how to deal with multiple payers and revenue sources. Specifically, they must learn how to work with a mix of Medicare/Medicaid managed care organizations, private payer insurance carriers, facilities-based care providers such as skilled nursing

In today’s climate of competitive bidding and lower reimbursement, it is challenging for DME suppliers to rely entirely on the assignment model, which meant that Medicare paid the suppliers directly and the patients only had to pay their copayments and deductibles. What we are now witnessing is that an increasing number of DME suppliers are electing to be non-participating and are billing non-assigned.   If a non-participating supplier provides a product on a non-assigned basis,