Billing & Reimbursement

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

VGM & Associates' podcast, "Industry Matters-Powered by VGM" is back with two new episodes this week.  Episode 45: 2020 HME Outlook and Leadership Chat with Miriam Lieber is the first episode of a new leadership series featured on Industry Matters. VGM's Lindy Tentinger is joined by Miriam Lieber, President of Lieber Consulting LLC, for an informal chat about the 2020 outlook for the HME industry, leadership, and employee engagement thoughts. Listen below or click

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.