October Educational Update

Important Reminders

  • An updated Fee Schedule was sent out this past week, current as of 9/1/2012. If you have not already received a copy please e-mail rrandazzo@accessintegra.com . Be aware that sometimes these e-mails end up in the ‘Junk’ or ‘Spam’ folder.

 

  • A special training session to review the WellCare of NY procedures has been scheduled for October 3 at 10am and 2pm. Please contact Rita in Customer Service if you would like to join the session.

 

  • Please revert to the Insurance List for all Integra contracted Healthplans. As always call us if you have questions regarding the Healthplans.

 

DME MAC Jurisdiction A Fall Webinar Schedule – Open Sessions

The DME MAC Jurisdiction A Outreach & Education Team still has the following FREE educational Webinar sessions open for registration.

All times Eastern Standard

October 02, 2012 from 9:30am – 11:30am Advance Beneficiary Notice of Noncoverage 

October 02, 2012 from 1:30pm – 3:30pm Durable Medical Equipment (DME) Modifiers

October 04, 2012 from 9:30am – 11:30am Orthotics & Prosthetics Billing Essentials

October 04, 2012 from 1:30pm – 3:30pm Lower Limb Prosthesis Billing

October 09, 2012 from 9:30am – 11:30am DME MAC Essentials I

October 09, 2012 from 1:30pm – 3:30pm DME MAC Essentials II

October 23, 2012 from 9:30am – 11:30am Orthotics & Prosthetics Billing Essentials

October 23, 2012 from 1:30pm – 3:30pm Advance Beneficiary Notice of Noncoverage

October 25, 2012 from 9:30am – 11:30am DME MAC Essentials I

October 25, 2012 from 1:30pm – 3:30pm DME MAC Essentials II

October 31, 2012 from 9:30am – 11:30am Lower Limb Prosthesis Billing

October 31, 2012 from 1:30pm – 3:30pm Durable Medical Equipment (DME) Modifiers

For further details please visit the “Events & Seminars” section of the DME MAC A Web site or click here.

 

 

 

 

September Educational Update

DME Coding Changes – Is your Head Spinning?

We all know how vital DME coding is to our business and how important it is to stay current with their policies. As you may already know CMS is making significant changes to the coding system and it is changing right before our eyes. In a joint effort, the NHIC DME Mac Jurisdiction A Provider Outreach & Education Team has partnered with the Pricing, Data Analysis and Coding (PDAC) Contractor to conduct two webinars focusing on the use of Durable Medical Equipment Coding System (DMECS).

The following topics will be discussed in these DMECS webinars:
  • What is DMECS?
  • Search by HCPCS Information
  • HCPCS  Details, Features, and Functions
  • DMEPOS Product Classification Listing
  • Sorting Results

Registration for these seminars is FREE however they are filling up fast so reserve your spot today! You can register by going to the website given below and following the links to courses titled “Durable Medical Equipment Coding System (DMECS) Training”  held at the following times;

September 18th 2012 from 2:30pm-3:30pm

September 20th 2012 from 2:30pm-3:30pm

Get Started By Clicking Here –> http://www.medicarenhic.com/dme/dmerc_seminars.shtml

 

10 Tips to Remember When Billing

1. The Date of Service (DOS) must be within the effective dates of the authorization. (For Example: If the authorization date range given is from 06/08/2012 to 07/09/2012, you must bill within these dates. Claims that fall before or after the authorization will be denied)

2. Place of Service (POS) must be “HOME” (12) for MetroPlus, WellCare, and HIP

3. Be sure to check the number of units, under the authorization to see how many units were approved.

4. Be sure to enter the member’s ID.

5. If you bill a rental under HealthFirst be sure to use an RR modifier. Do not use BR modifier.

6. When billing for rental items, please be sure to verify patient coverage for the DOS.

7. When performing  maintenance as a service, you must be bill every 6 months after the item was originally purchased.

8. Please do not change override charges when entering claims. The system is setup according to our contract rates.

9. Be sure to verify member’s maximum benefits for DME or Orthotics per calendar year

10. Cost invoice is required for all miscellaneous and unspecified procedures. (For Example: Manufacturer’s cost invoice is needed when billing code L2999, K0108, L3999, E1399, etc.)