Category: Billing and Reimbursement

Every Penny Counts: Reopen CURES Act Adjusted Claims for an Additional 5%

The CURES Act adjustments are complete, and providers can submit a written reopening for affected accessories used on non-bid manual wheelchair bases (complex rehab) to receive an additional 5 percent. While 5 percent may not seem like much, it can add up, and in this reimbursement environment every penny counts. When the affected accessories are used …

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Great News: Mass Adjustment Payments are Starting!

By Ronda Buhrmester and Dan Fedor, VGM Reimbursement Specialists We are hearing from DME providers that they are starting to receive payments from both DME MACS Noridian and CGS. Noridian’s dashboard is reporting 6.1 percent of Jurisdiction D has been completed as of July 5. Jurisdiction A has completed 11.4 percent of their adjusted claims …

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How to Navigate a Medicare System Limitation for Efficient Claim Submission

There is an ongoing issue with the Medicare processing system (VMS) denying accessories when more than nine line items are submitted. Due to a system limitation, when more than nine line items are submitted on one claim, the MAC processing system (VMS) splits the claim, and if the accessory codes are processed before the base item …

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If Suppliers Submit Assigned Claims, Then the Fee Schedule is Adequate Payment?

By Dan Fedor, Reimbursement Specialist, U.S. Rehab According to the following release from CMS, it appears that their logic is if suppliers submit assigned claims, then the fee schedule is adequate payment. But, we know that is not the case, as the fee schedule is NOT adequate payment for most codes! Assignment Rates CMS Releases 2016 Assignment Rates …

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Save the KU Modifier!

The KU modifier was established to allow reimbursement from the UNADJUSTED fee schedule for accessories used on Group 3 power bases for dates of service Jan. 1, 2016 – June 30, 2017. Yes, I said June 30, 2017, and as of today the KU will be eliminated come July 1, 2017. What this means to you is the reimbursement rate for …

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