Wrong use of modifiers is one of the most common reasons why DME claims get denied. There are several DME billing requirements that need to be fulfilled and billing the applicable modifier is one of them.
In addition to the right HCPCS codes for durable medical equipment items, many HCPCS codes also require a modifier. These modifiers are mainly used for providing more information about the durable medical equipment. When the right modifier is used, it can tell the HMSA if the item is new, rented on a capped basis or used. If the item has been rented on a capped basis, the right modifier will be needed to distinguish which month’s rental is being billed.
Modifiers will always be two digits for Medicare purposes. There are some modifiers that cause automated pricing changes and then there are others that are used for only conveying information. They are not required on all HCPCS codes; however, if there is a requirement and they aren’t submitted, then the claims will get denied.
Here are the categories in which most DMEPOS fall – Frequent and Substantial Servicing DME, Capped Rental, Prosthetic and Orthodontics and Customized DMEPOS, Inexpensive or Routinely Purchased DME, Oxygen and Oxygen Equipment.
Some of the common modifiers for durable medical items include RR (Rental), NU (Purchase of new equipment) and UE (Purchase of used equipment). There are certain categories for which modifiers RR, UE and NU are used, including capped rental items, oxygen equipment, inexpensive or routinely purchased items and items that need frequent and substantial servicing.
Here are certain key points that need to be considered if you want your DME claims to get paid on time:
- It is necessary to ensure that the medical necessity of the DME item has been accurately identified
- The necessity needs to be documented properly
- You need to report the right DME item and the right place of service
- You should know how the payer wants to report the DME item on the claims
Since the use of correct modifiers is important for getting paid, it is recommended to let experts handle the billing and coding procedure. By having a team of experienced billers, you don’t have to worry about denials and delays in payments. This one of the main reasons why many DME providers across the US are choosing to outsource their billing needs to a third party.