Billing & Reimbursement

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,

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) required CMS to remove social security numbers (SSNs) from all Medicare cards by April 2019. CMS replaced the SSN-based HICN with a new, randomly generated MBI. The new Medicare Beneficiary Identifier (MBI) is noticeably different than the HICN.  On August 19, 2019 CMS reissued the MLN Matters article SE18006 to show that all new Medicare cards have been mailed, to encourage providers to use the Medicare Beneficiary Identifier

Jeffrey S. Baird, chairman of the Health Care Group at Brown & Fortunato, PC, recently shared his insight on the managed care system in the DME industry. Over the last 12 years, the DME industry justifiably focused on competitive bidding, responding to audits, lower reimbursement, and stringent documentation requirements. Managed care was fairly low on the list of the industry’s priorities.  While we were focused on other priorities, managed care quietly became a large part

Same or similar denials occur when claims information is checked against the patient’s CMN history. This will indicate when equipment is “same or similar” to that piece of equipment being billed on the claim.  These types of denials can be avoided early on when providing DME equipment to patients. The essential step in preventing this type of denial is by having a thorough intake process. Suppliers are encouraged to use an intake form to assure all necessary information

An additional service available to EW members, the van Halem Group offers professional guidance on audits, appeals, compliance, enrollment, education and other complex issues. One of these issues include explaining to your referral source how to properly amend a patient’s medical record, particularly after the document has been signed. The van Halem Group is aware of this challenge and has provided a list of ‘Do’s and Don’ts’ to assist you in this particular situation.