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 –>


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.)

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