Category: Billing and Reimbursement

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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Medicare Establishes Set Fees for Custom Cushions (E2609) and Backs (E2617)….and it DOESN’T Sit Well!

This is a heads up to those who provide custom cushions (E2609) and backs (E2617) to Medicare beneficiaries! The Jurisdiction B and C DME MAC has decided to develop set fees for these custom items and did this internally without notice to the provider community. As of today, DME A and D has NOT implemented this change. …

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Unintended Consequences: Medicare Beneficiaries in Rural Areas are Being Systematically Denied Access to Care

Peter Thomas from the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition recently wrote an op/ed for The Hill on the effects of competitive bidding in rural areas and the application of competitive bid rates to CRT accessories. The impact of competitive bidding and increased scrutiny on mobility providers have forced providers into three options …

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Cushions and Backs Don’t REST ALONE on the Diagnosis Code

By Dan Fedor, VGM Reimbursement Specialist Skin protection/positioning cushions and backs ARE diagnosis driven; HOWEVER, a diagnosis code alone is NOT sufficient to meet coverage criteria! What this means is without a qualifying diagnosis code, the HCPCS code would be denied, but with a qualifying diagnosis code, it just meets the first part of the coverage criteria. During prior authorization, pre-pay …

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