DME Billing Services - What To Expect in 2019?

The DMEPOS fee schedule has been updated by the CMS for 2019 and several new codes have been added to the HCPCS file. For instance, from 1st January 2019, DMEPOS fee schedule file includes fees for three home infusion G-codes - G0068, G0069 and G-0070. For other new CY2019 codes, the fee schedule amounts will be established under the July 2019 DMEPOS fee schedule update.

Reportedly, the DME MAC will establish local fee schedule amounts for paying claims for new codes that are listed from 1st January 2019 through 30th June 2019. One HCPCS code (K0903) has been deleted from the DMEPOS fee schedule file that is effective from January 2019.

Fees has also been added for new HCPCS code (E0467). Fee schedule amounts are also being adjusted for shoe medication codes and mail order DTS. For CY2019, update factor of 2.3% has been applied to few DMEPOS fee schedule amounts. CMS is also implementing 2019 monthly fee schedule payment amounts for stationary oxygen equipment.

Proposed Rule by CMS

In 2018, CMS released the proposed rule that included potential changes to the DME payment rates. This long-awaited proposed rule is being considered positive because it includes vital improvements for payment in non-bid areas along with improvements to the CBP (Competitive Bidding Program).

It has been published by the CMS in order to drive innovation in DME and also to modernise it. Here are some of the highlights of this proposed rule:

•      Starting from January 2019 and until CBP contracts are awarded, it has been proposed that the beneficiaries will be receiving DME items from any Medicare enrolled DME supplier.

•      For DME furnished on or after 1st January 2019, CMS has proposed traditional fee schedule amounts.

•      For non-CBAs that are non-contiguous or rural areas, items furnished from January 2019 to December 2020 will be paid at 50/50 rates and for non-CBAs, items furnished will be paid at current payment rates.

•      CMS has proposed new payment classes for portable oxygen and oxygen equipment, new payment rules for ventilators and has improved payment rates for new DMEPOS items.

DME coders will have to be prepared for coding changes coming their way. For DME providers, the only way to survive 2019 will be through hiring experienced coders or by letting an reliable third party handle the challenges of DME billing. 

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