CMS dreams up billing nightmare

Wednesday, December 31, 2003

WASHINGTON - Starting this month, providers must change the billing anniversary date on a capped rental item to coincide with a beneficiary’s discharge from the hospital.

Previously, a patient’s billing anniversary date remained the same even if complications arose and he ended up in the hospital. Once the patient was discharged, billing resumed on his original anniversary date.

CR 2613 is intended to more accurately reflect a rental period, but it could create a billing nightmare for providers. That’s because billing systems typically are not programmed to accommodate new anniversary dates, said Asela Cuervo, AAHomecare’s senior vice president of government relations.

Additionally, CR 2613 will require suppliers to track the inpatient stays of all their beneficiaries and to change the anniversary dates to coincide with every new hospital discharge. Providers have no way to accurately do that in a timely fashion, said AAHomecare.

Even contacting patients monthly doesn’t guarantee providers will discover that a patient has been hospitalized since a patient could be admitted following the contact. If that happens, it’s likely several billing cycles will elapse before the provider discovers the new anniversary date and can change it. Payment for those claims then will have to be refunded and the claims resubmitted, creating significant work for the provider, Cuervo said.

The new policy also could impact a provider’s ability to bill secondary payers because many base their requirements on the anniversary date of the Medicare claim.

While the current system has its problems, it’s preferable to CR 2613, which will create confusion and achieve no significant cost savings for Medicare, Cuervo said.

As of press time, AAHomecare was lobbying CMS to scuttle CR 2613 or at least delay implementing it.