When a physician or therapist believes that a patient will benefit from a durable medical equipment (DME) supply or brace, it’s up to the office staff to determine what healthcare common procedure coding system (HCPCS) code should be assigned for billing purposes. Unfortunately, there are many more DME supplies than codes to choose from, and if you aren’t assigning the appropriate codes and managing your inventory properly, your practice will be the one to foot the bill!
Securing reimbursements is a group effort. Orthopedics, physicians, podiatrists, coders, clinical staff, administrators, managers, physician assistants, nurse practitioners, and anyone who manages DMEs in your practice need to work together to ensure that proper HCPCS codes are applied for supplies and braces.
Keep the DME Revenue Flowing
DME revenue is an important part of an orthopedic practice’s ancillary services. Remaining profitable starts with getting the best price from your vendors on the DME you dispense the most. But there are a number of other factors that play into your reimbursement, including:
- Product Knowledge. You need to understand the difference between off the shelf, custom fitted and custom fabricated braces. Differentiating between the different types of DME will help you choose the proper code.
- Coding Procedures. You must understand the steps you need to take to obtain and assign the appropriate HCPCS code for billing, as well as modifier requirements for clean claims.
- Inventory Maintenance. You need to know how to process reports from your practice management system to keep DME inventory and know what is being dispensed from your office.
- You must stay on top of collections to remain profitable: Don’t drag your feet on collecting payment from patients for self-pay items not covered by insurance!
Always Acquire an ABN
Even with proper coding procedures in place, there is still the risk of denial. Before you simply give your DME inventory away, insist that every patient sign an Advance Beneficiary Notice of Noncoverage (ABN). An ABN is essentially an agreement your patients sign stating that if their claim is denied by Medicare, they agree to pay for the product.
Not only is an ABN helpful in protecting your bottom line, it’s also required . The Centers for Medicare & Medicaid Services (CMS) outlines its rules for ABNs and states that “mandatory requirements apply to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. An ABN must be issued before DMEPOS suppliers furnish a beneficiary with an item or service that will not be paid for by Medicare because:
- The provider violated the prohibition against unsolicited telephone contacts;
- The supplier has not met supplier number requirements;
- The supplier is a non-contract supplier furnishing an item listed in a competitive bidding area; or
- Medicare requires an advance coverage determination, and the beneficiary wants the item or service before the advance coverage determination is made.
For more information on DME supplier requirements, visit https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c30.pdf.
Get a Leg up on Orthopedic Coding
Coding and orthopedics expert Lynn M. Anderanin will guide you on best practices in assigning HCPCS codes for supplies and braces in an audio conference for ProfEdOnDemand, “Coding and Inventory of DME for Orthopedics.” During this session Lynn discusses a proven way to manage inventory in the office, giving you the expertise you need to choose the appropriate code when reporting DME and prevent your reimbursement from walking out the door.
