Thursday, July 31, 2003

Enteral struggles

Q. Region A is denying our enteral claims for overlapping dates of service when we deliver and bill using a start-date that is before the end-date of the previous claim. The overlapping dates of service occur frequently as enteral supplies/formula are delivered before the patient runs out. How can I resolve this billing issue and be compliant with proof of delivery requirements?

A. The problem you describe is unique to Region A, and CMS is working with the carrier to make the necessary software changes to handle overlapping span dates. Your enteral supplies and formula that have been erroneously denied should be resolved through the appeals process.

Enteral claims must follow the proof of delivery requirements as stated in the DMERC manual. For example, if the enteral supplies/formula are sent to the patient via a delivery service, the beginning date of service on the claim must be the shipping date. For enteral supplies/formula delivered directly to the patient, the beginning date of service on the claim must be the date the beneficiary received the item. Billing enteral services based on a calendar month, beginning on the first of the month, does not meet Medicare’s proof of delivery requirements unless the delivery actually occurs on the first of the month.

Karen Moore is vice president of Ancor Healthcare Consulting. Reach her at 954-757-3121.