Did you know, in 2015, Medicare lost $3.2 billion due to improper medical billing for DME claims? Even today, DME suppliers have to encounter heightened scrutiny of their claims for obtaining Medicare payments.
In order to receive timely payments, it has become imperative for DME suppliers to demonstrate medical necessity of the durable medical equipment. Without securing and retaining the right documentation of medical necessity, obtaining Medicare payments can become a nightmare for those involved in furnishing DME and submitting claims.
All this has pushed the need to have expert billers and coders who are aware of the Medicare regulations and ICD-10 coding changes.
DME Code Changes
Here are some of the April changes to the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services.
Centers for Medicare and Medicaid Services (CMS) has not only added a diabetes code but also changed oxygen coding for the DMzcxE fee schedule by altering the HCPSC Level II modifiers.
Diabetic DME codes- there have been some changes that will affect coding of HCPCS Level II code K0903. According to the CMS, the fees for K0903 are set on the basis of fees for code A5513.
CMS released the DMEPOS fee schedule for 2019 that will be effective for Medicare claims that have a service date on or after 1st of January. Also, according to the AOPA (American Orthotic and Prosthetic Association), in 2019, the Medicare Fee Schedule for O&P services will also increase by 2.3% compared to the rates in 2018.
Surge in demand for trained coders
Coders need to pay close attention to the details of doctor’s procedures and diagnoses. They will have to use very specific ICD-10 and CPT codes to get reimbursed. For instance, if they are using billing diagnosis code F11.20 on a claim with procedure code 80307, it will reimburse them about $30 less than specifying the exact opioid being used by the patient.
To get paid on time, many suppliers have started outsourcing their billing needs to a third party. Outsourcing is giving them the opportunity to get reimbursed on time, without having to go through the hassles of keeping up with coding and regulatory changes.