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REPAIRS / BILLING By Peggy D. Walker, RN Billing & Reimbursement Advisor US Rehab/VGM – 800-401-3643 9/7/2011 V fax –877 907 3862 Mississippi Association.

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Presentation on theme: "REPAIRS / BILLING By Peggy D. Walker, RN Billing & Reimbursement Advisor US Rehab/VGM – 800-401-3643 9/7/2011 V fax –877 907 3862 Mississippi Association."— Presentation transcript:

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2 REPAIRS / BILLING By Peggy D. Walker, RN Billing & Reimbursement Advisor US Rehab/VGM – /7/2011 V fax – Mississippi Association 10/4/2011

3 When covered? When covered? Repairs to equipment a beneficiary “owns” are covered when they are necessary to make the equipment usable. The repair charge may include the use of loaner equipment when required. If the expense for repairs exceeds the estimated expense of purchasing or renting another item of equipment no payment can be made for the amount in excess. If claim is submitted for labor charge only, the claim should indicate the type of equipment being repaired. All repair claims must indicate that the pt. owns the equipment -name- make-model-when purchased & by whom---Block 19 for paper claim/narrative field elect. Can use code for base If you did not provide the original equipment you must have an order and documentation of continued need.

4 Coding Repairs for Patient Owned equipment Coding Repairs for Patient Owned equipment E1340/***K0739 ***effective 4/1/2009 is the code for labor (DME other than Oxygen) – 1 unit equals 15 minutes. (Needs to be broken down and explained) ie: 15 minutes to replace arm rests; 30 minutes to change brakes and bearings etc. K0462 – loaner equipment code while patient owned equipment is being repaired (paid up to one month rental) for any item not just w/cs State what item is: (K0823 power chair rental while patient owned _____chair is being repaired) pt owned when purchased and by whom. Must be complete K0740 is the repair code for Oxygen equipment

5 Billing & Modifiers ***RP***DELETED***1/1/ E1340 deleted 4/1/2009 Billing & Modifiers ***RP***DELETED***1/1/ E1340 deleted 4/1/2009 K0739 (4/1/09) would be first line with explanation of time units. (allowed amt 1 u $ ) K0462 – second line with explanation of base (item) provided and what item is being repaired. {NO MODIFIER REQUIRED} K0462 Does not have to be on same claim as repair “but” it is easier if it is. Use the code you are replacing with RB modifier for accessories and parts. KC modifier if replacing interfaces If using K0108,E1399, E2399 state name, make, model and MSRP of item using. No modifiers on these codes. NOTE – The new codes for power does not change the way you bill. You are not required to loan them the same base they are in – just a base they can use while you repair theirs. When using the NOC codes make sure you state what the item is first ie: custom foot box by _____ model # _______ MSRP _______ KX modifier required for all w/c accessories 5/1/07 mwc/11/06 pwcs NOTE – Replacement for prosthetics/orthotics will follow the 5year DME rule exception for Breast prosthesis only {these are 2 years or manf. warranty}!!! *** REPAIRS*** Part of Competitive Bid for items that are in the bid areas. New MODIFIERS KE == RA == RB ***RP***DELETED***1/1/2009 Effective April 1, 2009, for supplies and accessories to be used with beneficiary-owned equipment, ALL of the following information must be submitted in Item 19 on the CMS-1500 claim form or in the NTE segment for electronic claims: HCPCS code of base equipment; AND A notation that this equipment is beneficiary-owned; AND Date the patient obtained the equipment. NAME/MAKE/ & MODEL

6 K0462 Each claim submitted must include: Information on Equipment being repaired Information on Equipment being repaired Complete description (manf. model etc) Complete description (manf. model etc) Date purchased and by whom (can use base code) Date purchased and by whom (can use base code) Information on loaner equipment: (Can use base code) Information on loaner equipment: (Can use base code) Complete description /name/make/model Complete description /name/make/model Description and time needed for repairs Description and time needed for repairs It is not required to be billed on same claim as repair but works better if you do Why repair took longer than one day Suggest that you use the DMEPDAC code for item loaned as well to make pricing simpler.

7 MODIFIERS KX modifier is required on accessories KX modifier is required on accessories K0462 does not require any modifier K0462 does not require any modifier RA (effective date ) is the replacement of the DME RA (effective date ) is the replacement of the DME item itself (entire item is being replaced) RB (1/1/09)Replacement of a part of DME furnished as RB (1/1/09)Replacement of a part of DME furnished as part of a repair E0739 (4/1/09) does not require any modifiers but does E0739 (4/1/09) does not require any modifiers but does require a break out of unit needs. ** RP** deleted as of 1/1/09 {E1340 deleted 4/1/09} ** RP** deleted as of 1/1/09 {E1340 deleted 4/1/09} Use K0739 for labor on/after 4/1/09 Use K0739 for labor on/after 4/1/09 DO NOT FORGET the KE modifier on any part or accessory that could be part of round 1 CB base item DO NOT FORGET the KE modifier on any part or accessory that could be part of round 1 CB base item NO KE required on bases still use on Manual w/c accessories NO KE required on bases still use on Manual w/c accessories KK is replacement modifier for CBAs – for accessories on complex rehab bases that could be provided on group 2 CB items KK is replacement modifier for CBAs – for accessories on complex rehab bases that could be provided on group 2 CB items IN CBAs parts will be paid at the CB price (CAUTION) you do not want to go there – REMEMBER pts. in CB area can’t do non assigned. IN CBAs parts will be paid at the CB price (CAUTION) you do not want to go there – REMEMBER pts. in CB area can’t do non assigned.

8 Repair Questionnaire Patient Name: Medicare No. Address: Name, Make & Model of the item that is being repaired: ________________ Serial number of item being repaired: ________________ Date wheelchair (item) was provided: __________________ How was wheelchair (item) funded? (pay or source) ______________ Loaner chair given? Name ______ Make ________ Model ________ (----- code as well – for pricing information for K0462) If funded by Medicare was chair (item) purchased or rented? ________ If the wheelchair (item) was provided by a company other than ____________________________ the information above must be confirmed by the supplier ( if the supplier is unknown to the patient or out of business check per the VRU at Medicare for order date. Confirmed by: _______________(employee) Date: __ __ ____ Confirmed by: _______________(employee) Date: __ __ ____ *** NEED justification of continued need.***

9 MCM replacement policy If the item of equipment has been in “continuous” use by the patient on either a rental or purchase basis for the equipment’s useful lifetime, the “beneficiary” may “elect” to obtain a new piece of equipment. Replacement may be reimbursed when a new physician order and/or CMN, when required, is needed to reaffirm the medical necessity of the item. If the item of equipment has been in “continuous” use by the patient on either a rental or purchase basis for the equipment’s useful lifetime, the “beneficiary” may “elect” to obtain a new piece of equipment. Replacement may be reimbursed when a new physician order and/or CMN, when required, is needed to reaffirm the medical necessity of the item. …useful lifetime is determined through program instructions. In the absence of program instructions the “carriers” may determine the reasonable useful lifetime but at no time can it be “less than” 5 years. …useful lifetime is determined through program instructions. In the absence of program instructions the “carriers” may determine the reasonable useful lifetime but at no time can it be “less than” 5 years.

10 KE Modifier List KE Modifier List Standard Power Accessories E0950 through E0957, E0960, E0973, E0978, E0981, E0982, E0990, E0995, E1016, E1020, E1028, E2208, E2209, E2210, E2361, E2363, E2365 through E2371, E2381 through E2392, E2394, E2395, E2396, E2601 through E2608, E2611 through E2616, E2619, E2620, E2621, K0015, K0017 through K0020, K0037 through K0047, K0050 through K0053, K0098, K0195, K0733 through K0737, Complex Rehabilitative Only Accessories E1002 through E1008, E1010, E1029, E1030, E2310, E2311, E2321 through E2330, E2351, E2373 KC*, E2374 through E2377 (* When E2373 is used as a replacement only on a competitively bid complex rehabilitative product (K0835 – K0864), use the KC modifier but not the KE modifier. When used as a replacement only on a non-competitively bid manual or miscellaneous wheelchair, use the KE modifier, but not the KC modifier.) The KE modifier should also be used for tips (A4637) and hand grips (A4636) when used on a non- competitively bid cane or crutch, but not when used for a competitively bid walker (E0130, E0135, E1040, E0141, E0143, E0144, E0147, E1048 or E0149). The disposable canister code (A7000) requires the KE modifier when used with respiratory or gastric suction pumps, but not when used for a competitively bid negative pressure wound therapy (NPWT) pump (E2402). When providing an IV pole (E0776) with non-competitively bid parenteral nutrient codes, use the KE modifier, but not the BA modifier. When providing the IV pole for competitively bid enteral nutrient codes (B4149, B4150 and B4152 through B4155) use the BA modifier, but not the KE modifier.

11 KE Modifier example billing January 1, 2009 the KE modifier was added to show that an item/accessory billed is being used on a non competitive bid item so that the allowable will not be decreased 9.5% January 1, 2009 the KE modifier was added to show that an item/accessory billed is being used on a non competitive bid item so that the allowable will not be decreased 9.5% When billing for two units that requires the RT and LT modifier use: When billing for two units that requires the RT and LT modifier use: E0973NUKERT99 then in narrative field put the LT and KX modifiers. E0973NUKERT99 then in narrative field put the LT and KX modifiers. NU for new – KE for non CB item-RT for right -99 (>4modifiers required) LT (left) KX (doc. on file for Medical necessity NU for new – KE for non CB item-RT for right -99 (>4modifiers required) LT (left) KX (doc. on file for Medical necessity

12 Type of Equipment Part Being Repaired/Replaced Allowed Units of Service (UOS) Power Wheelchair Batteries (includes cleaning and testing) 2 Power Wheelchair Joystick (includes programming) 2 Power Wheelchair Charger2 Drive wheel motors (single/pair) 2/3 Power or Manual Wheelchair Wheel/Tire (all types, per wheel) 1 Power or Manual Wheelchair Armrest or armpad 1 Power Wheelchair Shroud/cowling2 Manual Wheelchair Anti-tipping device 1 Hospital Bed Pendant2 Headboard/footboard2 CPAP Blower Assembly 2 Seat Lift Hand Control 2 Seat Lift Scissor mechanism 3 Patient Lift Hydraulic Pump 2

13 REPAIR AUDITS 2010/2011 Asking for face to face for power Asking for face to face for power Asking for proof of continued Medical necessity for all items ** IMPORTANT IF YOU DID NOT PROVIDE THE EQUIPMENT** Asking for proof of continued Medical necessity for all items ** IMPORTANT IF YOU DID NOT PROVIDE THE EQUIPMENT** Look back period past 6 months Look back period past 6 months What this means is that you need to make sure the item you are providing has documentation of continued need within the past 6 months. What this means is that you need to make sure the item you are providing has documentation of continued need within the past 6 months. If no original face to face for power it is best to make sure you have one. If no original face to face for power it is best to make sure you have one. This is resulting in need for ABNs and lots of non- assigned claims This is resulting in need for ABNs and lots of non- assigned claims


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