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Ronda Buhrmester

Billing: Meet all requirements

Q. Can there be a review on continued medical need vs. continued use and the requirements?

A. For ongoing supplies and rented DME items, in addition to information justifying the initial need of the items and/or supplies, there must be information in the medical record to support that the item continues to remain medically necessary.

Billing: Prepare by self-auditing

Q. A recent OIG report discussed replacement CPAP supplies that do not comply with the Medicare guidelines. What is the correct documentation to collect?

A. Don’t take for granted the documentation requirements for refill requests. CPAP supplies fall under the non-consumable guidelines, which are more durable requiring periodic replacement.

Billing: Don't fall for misconceptions

Q. As our company is executing more non-assigned claims, ABNs are being utilized more frequently. Are ABNs required for non-assigned claims?

A. The quick answer is maybe. Let’s start with some misconceptions in the industry about non-assigned claims. 

Billing: Get back to basics

Q. The industry focus has changed due to lower reimbursements, stringent documentation requirements, and working with a leaner staff making intake key. Can we go back to the basics of reviewing the intake process?

A. Your intake team is responsible for collecting the order, medical records and supporting documentation. If any required information is missing or inaccurate, the team must go back to the referral source to obtain the correct information and explain why it is needed.

Q&A: VGM’s Buhrmester & Fedor

‘There can be a lot of gray areas, so you need all the information you can get’

WATERLOO, Iowa – Just when HME providers think they have control over documentation and billing, Medicare throws them a curve ball.