Billing & Reimbursement

By Nikki Jensen, VP, Essentially Women Breastfeeding babies has been going on since the beginning of time. None of us would be here if our foremothers had not been able to breastfeed their children. That’s why it’s so strange to think of the “modern age” of breastfeeding to have only started in the mid-1990s. To clarify, we’re not referring to baby formula. We’re talking about breast pumps and a mother’s ability to pump at home—and what makes

By Craig Douglas, VP, Payer and Member Relations, VGM Government Relations Since the onset of COVID-19, there have been challenges facing DME/HME providers, not the least of which was a sharp increase in costs pertaining to several facets of their business. Acquisition costs for many products have been rising steadily in the form of incremental price increases. Fuel costs, delivery vehicle costs, and labor costs have also been on the rise. Hiring and retaining qualified and reliable staff has

By Wayne H. van Halem, AHFI, CFE, President, The van Halem Group The Recovery Audit Contractor (RAC) Program wreaked havoc in the DMEPOS industry from 2011 until about 2015 when they were essentially given free rein to audit DMEPOS claims.  While there were limits as to how many claims they could audit from a unique provider, there was no limit on how many providers could get audited. And for a while, it seemed no one was immune. The RACs get paid a contingency on any overpayments and

August 3rd seems to be an important date for CMS. On August 3rd, the DME MACs, SMRC, and RAC will be able to resume audit activity.  Here is a recent update from the “Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs)” that are attached as well.  Prior Authorizations will resume as business as usual for PMDs and Group 2 Support Surfaces.  Also, the lower limb prosthetics (6 codes) will begin prior authorization activity

By Ronda Buhrmester, Sr. Director of Payer Relations & Reimbursement This article was first featured in Essential Advantage Q2 2020 An important topic that comes up when providing services for patients during the public health emergency (PHE) reimbursement. Reimbursement is essential to all providers, especially now. As providers are adjusting the ways in which they provide services for their patients, it is important to note proper reimbursement guidelines. The information below refers

Many EW members who have billed Medicare in 2019 have received a check for the relief payment, but within that check states that they are required to sign an attestation form and agree to terms and conditions. Many are confused about particular items in these terms and conditions, including the statement that they must be involved in providing care for COVID-19 patients and use the funds to provide care or respond to COVID-19.  Craig Douglas, VP of Payer and Member Relations for VGM & Associates,

Essentially Women Members: Are you looking for information about all the different government programs? We have you covered. Paycheck Protection Program (PPP) General Info: Click Here Update 4/16/20 Update 4/21/20 CARES Act Payments: Click Here Update Economic Injury Disaster Loan Emergency Advance This program was offered as part of the CARES Act.  SBA Information Link Economic Stimulus Programs – COVID-19 Resource Tool – this

Medicare and commercial insurers are pushing providers and suppliers away from the traditional fee-for-service (“FFS”) reimbursement model and towards a coordination of care reimbursement model. Under the coordination of care model, reimbursement is tied to patient outcome, which is dependent upon providers and suppliers working together. CMS and the OIG have correctly determined that the federal anti-kickback statute (“AKS”), the beneficiary inducement statute, and the

Payer requirements and policies change frequently. It's hard for companies to keep up with all of the changes. There are some responsibilities that you can put into place to hopefully catch changes before you find out the hard way and before your cash flow suffers.  Dawn Chapman from Chapman DME Billing discussed with HME News five tasks to consider, including reviewing contracts, assigning payer groups to a team member, signing up for email communications, get access to provider portals,

In a recent article from Medtrade, Jeffrey Baird explains how suppliers can bill for Part B for patients that reside in a skilled nursing facility ("SNF").  The typical process for patients that are admitted to SNF include staying in the SNF for a limited number of days. While in the SNF, the patient will receive rehab services designed to strengthen the patient so that he can return home. Medicare does not pay for custodial care. Conversely, Medicare does pay for skilled nursing