DME Modifiers- AU, AV, AW, KM & KN and List of Medicare Modifiers

 Durable medical equipment (DME) modifiers play a crucial role in DME billing and coding. Since we have Medicare grabbing the highest position in the insurance service provider sector, it is ideal that you know about a few of the important CPT and Medicare modifiers before you take a step with your claim/reimbursement.

What are these DME modifiers – AU, AV, AW, KM, & KN and what are they meant for?

There are a number of existing DME modifiers that have been into use for quite a long time now. Now, these modifiers have been recently added to the list of HCPCS in order to identify the DMEPOS supplies that are covered under the relevant category.

What is a modifier and how does it affect your payment?

A modifier can be dedicatedly defined as a change indicator in the service or procedure that has already been performed, without changing the nature or definition of the code. In other terms, it can also be called as alternative codes to previous claims in case any modifiers are newly added to the HCPCS list.

This list has to be kept updated and should be entered rightly in the claim form while submitting; otherwise, it may take a lot of time and effort to process the specific claim. You should place the modifier in the right place while claiming. Misplaced modifiers may not be considered or will not be progressed for reimbursement unless you submit proper documentation supporting the modifier, thus affecting the payment of your claim.

What is the purpose of using a modifier on a Medicare claim?

Depending on the modifiers on a Medicare claim, any missing or additional information required for the claim is submitted and the payment for the code is also determined.

Now let us take a deep look into the newly added codes AU, AV, AW, KM, & KN.

AU-It is used for items furnished in relation to the supply of urological, ostomy, or tracheostomy.

AV- It is used for items furnished in relation to the supply of a prosthetic device, prosthetic, or orthotic.

AW- It is used for items furnished in relation to a surgical dressing.

These three modifiers are applicable to codes A4450, A4452, and sometimes AU for A4217 as well. DMEPOS providers should use these modifiers in case they come across A4450, A4452, or A4217. In the future, it is also possible to get other codes in relation to these new modifiers. Medicare decides its payment for the codes A4217, A4450, and A4452 no matter if these modifiers are specified or unspecified.

KM- It is used for the replacement of facial prosthesis that contains a new impression or moulage.

KN- It is also used for the replacement of facial prosthesis that uses an existing master model.

The codes L8040 and L8047 determine facial prostheses for which the KM and KN modifiers can be reported to the provider in the claim form. Medicare contractors’ base payment is valid only if these modifiers are present in the form and can be used only when the prostheses is replaced.

How to understand the importance of modifiers?

It is not necessary for a provider to approve your claim because it is just covered and the service is reimbursable. Before you provide the modifiers, it is important that you clearly go through the rules of Medicare during claims. It is the provider’s responsibility that before submitting claims should be aware of the Medicare reimbursement program requirements.

Proper guidelines for using modifiers

The following guidelines can get your payments properly for the DMEPOS services you offer. This will help you avoid the possibility of getting claims rejected.

·        Always use valid modifiers.

·        Go through the claim form properly and indicate the valid modifier in the respective column

·        Do not specify any additional information next to modifiers because sometimes system may not be able to read it correctly.

·        Do not give excessive spaces between one modifier and another.

·        Avoid using punctuation in the places where you need to enter modifiers.

Conclusion:

If you require any free consultation on your DEMPOS claims, the 24/7 Medical Billing Services Company offers prompt solutions through an expert’s team. If you are looking for HCC Coding, Medical Billing Audit/Consultation, Insurance Credentialing Consultation, and more, contact the customer support team of 24/7 MBS for reliable and high-quality service.

An Overview of CPT Codes in Medical Billing

 

We have heard the word CPT often in DME billing and coding. What is so unique about these CPT codes, and why they play a prominent role in the process of DME medical billing and coding? CPT stands for standard procedural technology are number codes assigned to any service provided by a medical practitioner to a patient. It includes services such as medical, surgical, and diagnosis. These CPT codes are prominently used by insurers to decide and declare the reimbursement amount that a practitioner receives for a particular service.

It would be best to remember that both CPT and HCPCS are healthcare codes but serve different purposes. In general, DME billing uses CPT codes, whereas if you use Medicare, it uses HCPCS codes.

How to understand CPT codes?

A CPT code appears mostly in numbers of integers as a 5-digit code and sometimes, can even appear in alpha-numeric. Depending on reasons what you claim for, the CPT code varies. There are specific standard CPT codes used for everyday activities performed by a practitioner such as general check-ups.

The American Medical Association owns the complete copyrights of these CPT codes and even maintained by them. Since changes are frequent in any industry, healthcare is not least in that aspect. When new services are introduced, the CPT codes keep revising, and obsolete codes are replaced with new codes sometimes.

The amount of reimbursement may vary depending on the service you provide, and even the contracts between insurers and individual providers may also impact. To make it more simple and clear, CPT codes have different categories, which include the following:

Category 1 contains devices and drugs, along with vaccines, category 2 consists of performance measures and quality of care; category 3 consists of services and procedures that use emerging technology. Under category 4, you have PLA codes, which come in alpha-numeric and used for lab testing.

Some sample CPT codes for your knowledge

·       99214 for an office visit

·       99397 for a preventive exam in case the patient is more than 65 years of age

·       90658 for validation of a flu shot

·       90716 for chickenpox vaccine and more

How to use CPT codes properly?

CPT codes directly impact how much a patient pays for hospitals, medications, offices, and other medical facilities. Depending on these factors, the AMA stringently creates and follows CPT codes. The CPT coding process is generally handled by certified and professional medical billing and coding service providers to ensure that procedures are followed appropriately.

Let us take a look at the steps involved in a medical coding process when outsourced.

Initial coding

There are two ways that a practitioner follows to initiate the medical coding process at their end. Either to manually write down the code then and there when you visit or maintain electronic health record (EHR) and enter it in the system by identifying the code with the help of service name.

Verification and submission

Your records are analyzed, reviewed, and then assigned with correct codes by your practitioner. Lastly, your practitioner's billing department submits the list of services you were offered to the insurer.

Claim processing

To process the claim, the CPT codes are more important, and your insurer uses it. Based on the codes, your reimbursement amount is entirely dependent, and in this stage, your insurer will decide how much to pay the doctor and how much to pay the patient.

Research

Insurance companies and government statisticians use coding data to estimate future healthcare costs or charge for their patients. Moreover, the trend in medical coding can be tracked through performing intensive research.

Where to look for CPT codes?

Wherever you find documentation while the transition of your healthcare records, you can find CPT codes. Also, you can find CPT codes in the discharge paperwork provided by the doctor. You can see the summary report filled with numeric code, which is called a CPT code that appears in five characters.

Similarly, you can find CPT codes in your medical/service bills from the doctor and explain the benefits of your insurer.

Conclusion

CPT codes are not complicated but quite challenging to differentiate between ICD codes, and them. Anytime, suppose you need help on DME medical coding & billing process. In that case, you can directly approach the experts' team of 24/7 Medical Billing Services, the best healthcare company to outsource your coding and billing processes.

Why Revenue Leakages Happen in DME Billing and Coding?

The phenomenon is especially common in the Durable Medical Equipment (DME) billing & coding industry because of the inherent cumbersome nature of DME billing. Revenue leakages are a major concern in the healthcare industry. They are the difference in the claimed amount that healthcare providers are entitled to receive versus the amount of the reimbursement they actually receive.

●       As per the Harvard Business Review, the top hospitals have lost hundreds of millions of dollars of income due to revenue leakages.

●       As per American Hospital Association, all kinds of U.S. hospitals reported approximately $620 billion in uncompensated care costs since 2000.

 

Top reasons why revenue leakages happen in DME billing and coding:

• Denial of claims: 20% of all revenue loss is due to denial of claims. Claims can majorly be denied if:

1. Demographic Information of the patient is incomplete.
2. Information is missing or invalid.
3. Medical Necessity of DME usage is not clearly mentioned.
4. CPT code, Modifier, PIN, or NPI is incorrect or missing.
5. Duplicate claim or service is found.

• Inaccurate codes: Another common reason for revenue leakage is incorrect coding of accessories or equipment. Only when the DME biller identifies the right HCPCS level II codes and sends over the claim with authorization paperwork, the insurance company will pay the claim.

• Non-compliance: All the guidelines laid down by the Health Insurance Portability and Accountability Act (HIPAA) and the Office of the Inspector General (OIG) must be followed to the last bit in order to prevent complete rejection of your claims and thereby leakages in revenue.

• Lack of real-time monitoring: There’s no substitute to correct and real-time data. If that’s not available and there are discrepancies in your data, be sure of major revenue leakages. Why? Because without real-time data, decisions will not be backed up by accurate data. For example, if the insurance policy does not cover a specific treatment, this can be communicated to the patient and the provider beforehand so that there are no issues in the DME billing.

• Incorrect data: Inaccurate data entry in the database can give rise to mismanagement of funds and thereby revenue leakage. Until the data is meticulously collected and analyzed by experts, error-free billing is a distant dream.

• Failure to Follow-up: Failure to follow-up regularly can sometimes lead to non-payment of claims. If there’s a delay or the claims are outrightly rejected, DME billers need to follow up or resubmit the claims to avoid revenue leakage.

• Lack of expert guidance: By now you know that DME billing is an exhaustive process and must not be handled without expert guidance. Revenue leakages mainly happen when non-professionals venture into it and do not adopt DME billing outsourcing. Billing professionals can help you avoid errors, identify loopholes, get payments on time, manage denials and rejections of claims, and streamline the entire billing process so that you receive the payments you deserve. 

The first step to avoid all forms of revenue leakage in DME billing and coding is to identify the loopholes. By giving the process in the hands of experts, you ensure that you’re focusing on what you’re best at - treating patients, which by the way will lead to revenue generation in the long run.

 

About 24/7 Medical Billing Services

24/7 Medical Billing Services is the nation’s leading medical billing service provider catering services to more than 43 specialties across the entire 50 states. You can rely on us for end-to-end revenue cycle management. We guarantee up to 10-20% increase in the revenue with cost reduction of your practice for up to 50%.

Call us today at 888-502-0537 to know more on how we can help boost profitability for your practice.

 

Media Contact:

Hari Sudan, Media Relations,

24/7 Medical Billing Services,

16192 Coastal Hwy,

Lewes, DE – 19958

Tel: + 1 -888-502-0537

Email - info@247medicalbillingservices.com

Website – www.247medicalbillingservices.com

24/7 Medical Billing Services offers DME Billing at just 8 USD per hour

The advanced medical technology, the increasing rate of chronic diseases is a key factor for the expansion of the Durable Medical Equipment (DME) Billing market across the globe. Aged individuals are more prone and susceptible to health disorders and problems such as heart diseases, diabetes, kidney failure, arthritis, and many others. This has resulted in the creation of a separate market for various DME products and equipment such as crutches, walkers, wheelchairs, traction and trapeze equipment, hospital beds, oxygen and respiratory equipment, patient lifts, infusion equipment and supplies and several others. The increasing growth rate of the aged population is one of the major reason for the surge in DME billing.

Durable Medical Equipment (DME) billing is quite different and unique from medical billing and other coding procedures. DME billing is a highly complicated and intricate process. It requires extensive, in-depth, and robust knowledge about the DME process, industry mandates, and all the HCPCS level II codes. All Durable Medical Equipment and products are categorized under the HCPCS level II codes. Since expensive medical equipment needs to be purchased, DME billing and coding specialists need to be aware of how to code claims accurately and the timing of claims submission to get the proper reimbursements.

 

DME billing and coding process

• Medical practitioner prescribes the necessary medical equipment for the patient.
• Documentation of the patient information and key details.
• Preparation of documents for claims submission citing the reasons why the medical equipment is prescribed to the patient.
• Stringent eligibility check and pre authorization to find out whether the patient is applicable. 
• Required permission from the insurer is initiated.
• Initiation of the coding process. This involves identifying the correct HCPCS Level II codes from the HCPCS manual.
• Stringent checks are performed to ensure that every accessory and part of the equipment is correctly coded.
• Once the coding stage is completed, the DME billing company files the claim along with the necessary paperwork to ensure that the insurance company pays the right amount to the healthcare service provider.

• Frequent follow-up on the claims by the DME billing company.

 

Challenges and problems in DME billing and coding

DME billing and coding can become highly challenging and demanding if you don't have skilled and experienced billers and coders. There are several complexities and challenges associated with DME billing. Some of these include gathering and compilation of proper patient data, patient validation, obtaining authorizations, use of the correct forms for claim submission, and HIPPA compliance.

1) Use of redundant and obsolete software

Lack of proper knowledge about the latest DME billing software and use of old backdated software results in unsuccessful billing.

2) Lack of proper documentation

The DME billing process is quite tedious and exhaustive. This is why many billers miss on minute details in the documentation resulting in claim denials.

3) Incompetent resources

Most healthcare providers hire limited DME billers and coders since it is extremely extensive to have a huge team onboard. Working with limited team strength will increase the burden and workload on them. Too much pressure and limited time affects their productivity and efficiency as well, which may lead to errors in the DME billing process.

 

Outsourcing - An effective way to come out of all DME billing challenges

With the increasing demand and rising salaries of DME billers and coders, the majority of healthcare practices are opting for outsourcing their Durable Medical Equipment billing requirements. This is because outsourcing is not just a convenient option for them but a cost effective one too.

 

24/7 Medical Billing Services - Simplifying DME billing complexities for you

24/7 MBS is a popular name in the DME coding and billing industry across the globe. We have onboard a highly skilled and experienced team of coding and billing professionals who have in-depth technical knowledge and expertise in DME documentation requirements. They always remain updated regarding any major changes happening in the DME billing industry. 

Our team would handle everything associated with DME billing and coding from start to end - from identifying cases that are eligible for reimbursements, claim documentation, and timely submission.

Whether you are a well-known healthcare center or an independent medical practitioner, our tailor-made DME billing services are set up as per your requirements. We understand that the requirements of each healthcare provider is different, hence we do not follow a one size fits all approach.

Partnering with us will enable you to streamline your billing process. You can rely on us to prepare claims with accurate codes and submit them to the relevant insurance authorities to get timely reimbursements.

Being one of the leading providers of DME billing services, we have assisted several independent physicians, hospitals, and nursing homes across the country and worldwide in increasing their revenue generation from claims.

In order to help DME billers and coders, 24/7 MBS has produced several helpful educational videos on effective billing and coding tips. 

The main objective behind our DME billing and coding services is to reduce the workload and pressure on physicians and medical practitioners. Our services empower them to focus on what they are best at doing, i.e. taking care of their patients. In order to extend the benefits of our services to everyone, we have recently introduced DME billing on an hourly basis, at just 8 US dollars per hour" says Harry, CEO, 24/7 Medical Billing Services.

 

DME billing services at just USD 8 per hour - A new initiative by 24/7 MBS

In an attempt to simplify things for medical practitioners and healthcare centers, 24/7 MBS is offering DME billing and coding services at just $ 8 per hour. 

"Any medical service provider can reduce their AR in just $ 8 per hour. This is a one of a kind initiative launched by us and is strictly a limited period offer. The reason behind launching this scheme is to cater to the needs of startups and independent medical practitioners within a limited budget. This special initiative is aimed at giving you the highest collection rates and reducing your AR bucket by a significant margin. " says Ken Staten, Sales Director at 24/7 MBS.

Ken elaborated further, " If you choose us as your medical billing partner and sign up for the limited period offer, we would be providing free credentialing -services as a part of the extended service agreement. We specialize in medical credentialing and have already credentialed thousands on the insurance panels. We'd love to credential you too!"

 

Distinctly different medical billing services from 24/7 MBS

Are you a startup healthcare center or a new medical practitioner? Are you looking out for outsourcing your DME billing work to a company who has expertise in Brightree, BFLOW, and Advanced MD. Our unique and different $ 8 dollars per hour billing services can provide you with a plethora of benefits.

1) Eliminates the chances of billing and coding errors

Being experts in the coding industry, we perform constant stringent quality checks which nullifies the chances of any errors in the DME billing process. This is something which your in-house experts won't be able to do easily.

2) Saves valuable cost and time

Outsourcing your DME billing work to us helps you to reduce your operational costs by a significant margin. Moreover, you can focus on your patients rather than spending unnecessary time overlooking the billing process.

3) High collection rates

Our DME billing services help you achieve the highest collection rates and reduce your AR bucket by a great number at just $ 8 per hour.

 

About 24/7 Medical Billing Services

24/7 Medical Billing Services is the nation’s leading medical billing service provider catering services to more than 43 specialties across the entire 50 states. You can rely on us for end-to-end revenue cycle management. We guarantee up to 10-20% increase in the revenue with cost reduction of your practice for up to 50%.

Call us today at 888-502-0537 to know more on how we can help boost profitability for your practice.

Media Contact –

Hari Sudan, Media Relations,

24/7 Medical Billing Services,

16192 Coastal Hwy,

Lewes, DE – 19958

Tel: + 1 -888-502-0537

Email - info@247medicalbillingservices.com

Website – www.247medicalbillingservices.com

How to execute Billing for DME, Orthotics, and Prosthetics in Private Practice?

Durable medical equipment (DME) billing is quite a long process but definitely an achievable one; similarly, it is for Orthotics and Prosthetics billing as well, in a private practicing environment. You can buy few items in online or even in the physical store by paying out quick cash and take the product along with you, which cannot be applicable when it comes to DME billing and billing for Orthotics and Prosthetics. In fact, by doing so may end up in rooms filled with errors. There are certain guidelines that can be followed to streamline DME and other billing processes, which help your patients to gain what they need and pay you what you are supposed to receive.

#1: Generating a DME service provider number

To obtain reimbursements for your DME supplies, splints, orthotics, and other supplies, you must have a DMEPOS number. This number is your proof that shows you are a DME supplier. Licensing is different from DMEPOS supplier number. Since your claims should come through Durable Medical Equipment Regional Carrier (DMERC), it is not easy to get over the process without providing the DMEPOS number while applying.

Here are certain things you need to know before applying for the DMEPOS number:

·       The entire application process might take at least 60 business days before enrolment.

·       A Medicare inspector can come and visit your place before issuing the supplier number.

·       You may have to re-enrol after three years and likewise, another Medicare inspector makes an attempt to visit your place and only then, the supplier number is issued to you.

#2: Mark the right codes

Choosing the right code according to the service you provide might be a challenging one. The codes can be of different types according to categories for DME billing, Orthotics, or Prosthetics.

Here are some tips to know how these codes can vary:

·       Prosthetics Initial Encounter Code : 97761

This CPT code can be used for any prosthetics-related instructions or interventions by providers. But it is applicable only to the initial encounter.

·       Orthotic and Prosthetic Management: 97763

This CPT code comprises activities similar to codes 97761 and 97760 but can be used for subsequent encounters if any.

·       Splinting and Bracing: L-codes

If you are billing for splints, braces, and any other services of fabrication, assessment, and supplies, these HCPCS codes are necessary. You cannot bill any other code while billing L-codes.

#3: Reimbursement

This is foremost important because it is the reason behind the execution of DME Billing. All three Orthotics, Prosthetics, and DME billing includes different parameters under several categories. For example, if you take Orthotics reimbursement, Medicare can ask you for evaluation, fitting, parts and labour, adjustments made while fitting and not more than 90 days from the delivery date, or repairs if any due to regular usage and exposed to wear or tear within 90 days from the date delivered.

#4: Choosing between Renting and Selling DME

Before you rent or sell a DME item to your patient, your DMERC expects you to intimate them about your patient’s decision whether buying or selling. You can mention any of these modifiers in the claim form while you submit it to the DMERC.

·       Choose BR if your beneficiary has opted for renting the item.

·       Choose BP if the beneficiary has opted for buying the item.

·       Choose BU if you have notified both the options to the beneficiary but have not made their decision within 30 days.

#5: Proving Medical Necessity

For few items, you should provide a certificate of medical necessity (CMN) and moreover, the list of items may vary across the DMERCs. But there are certain common items such as TENS units, wheelchairs, CPAP machines, osteogenesis stimulators, hospital beds, power-operated vehicles and more.

 Conclusion

These are certain criteria that you can consider while executing DME billing, Orthotics & Prosthetics billing, preferably if you are a private practitioner. 24/7 Medical Billing Services is an expert who have achieved milestones across verticals in the DME billing and coding process. They provide free consultation on obtaining DMEPOS supplier number and the complete process for successful establishment.

 

About 24/7 Medical Billing Services

24/7 Medical Billing Services is the nation’s leading medical billing service provider catering services to more than 43 specialties across the entire 50 states. You can rely on us for end-to-end revenue cycle management. We guarantee up to 10-20% increase in the revenue with cost reduction of your practice for up to 50%.

Call us today at 888-502-0537 to know more on how we can help boost profitability for your practice.

 

Media Contact:

Hari Sudan, Media Relations,

24/7 Medical Billing Services,

16192 Coastal Hwy,

Lewes, DE – 19958

Tel: + 1 -888-502-0537

Email - info@247medicalbillingservices.com

Website – www.247medicalbillingservices.com