Reimbursement

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Thursday, January 31, 2002

Careful: Repair work can be tricky

WITH NANCY BURMA
Q: We want to provide repair services to our patients, even to new patients, but we are reluctant because reimbursement is so difficult. Any suggestions?

A: Do NOT dabble with service/repair and its reimbursement issues. Do your homework first. Not only do you need to know what the reimbursement issues are, such as current cuts in the labor allowable, but you need to establish a procedure for your company to follow.

First, you must determine ownership of the equipment needing repair. If you provided the wheelchair and know that Medicare, Medicaid or another third- party payer purchased it, you do not have an issue. However, if you repair an item that the patient "thinks" he purchased from another company, you may find out quickly that the item was a capped rental when you get that Medicare denial for your repair charges. You need to determine before you do the service: when it was purchased, who paid for it, and does the patient own it.

Also, remember that there are varying degrees of medical necessity documentation required. Medicare will only pay for the repair of medically necessary, patient-owned equipment. While there is no need to send a CMN for the repair of a hospital bed with the claim, if you did not provide the bed to the patient, you may want to see if the patient meets the medical necessity criteria for the bed before you accept assignment on repair. Additionally, what you are repairing may be covered under warranty. While you may not charge for the replacement parts, you may be able to charge labor for your service technician's time. Check with your manufacturer and payer.

Lastly, once you have begun to do repairs, track your reimbursement. Watch for patterns such as Medicare denials that say the patient does not have a hospital bed. Even though you may have made the ownership statement on your claim, if that payer did not purchase it, they may not be satisfied until they see proof of ownership and medical necessity.

Nancy Burma is president of Alternative Billing Solutions. Reach her at 952-881-1767.

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