Category: Billing and Reimbursement

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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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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