CMS Documentation Requirements for Durable Medical Equipment

Event Information
Product Format
Prerecorded Event
Presenter(s)
Lynn M. Anderanin, CPC, CPPM, CPC-I, COSC
Length
60 minutes
Product Description

Meeting CMS Documentation Requirements for DME to Avoid Overpayments and Recoupments in Medicare

Durable Medical Equipment (DME) supplies are paid by Part A Medicare instead of Part B, like all other services for physicians, and so, those wanting to be reimbursed by Medicare must enroll as a DME supplier. Once you are able to submit DME claims to Medicare, CMS has very specific guidelines as to what documentation you should have in your medical record for DME dispensed to patients. Should you be audited? Do all of the required documentation require to be present? Or is it necessary that payments may have to be returned to Medicare at a financial loss to providers?

DME has been a target of potential fraud and abuse by Medicare and the OIG relating to fee-for-service provider practices for several years. Medical necessity guidelines have become very detailed with explanation on what kind of documentation is required to substantiate a DME supply for a patient. Medicare is auditing providers making to prove that patients qualify for particular DME, as well as document whether the DME has been received by the patient and not reported before the patient receives it. Not meeting the documentation requirements can cause what Medicare considers overpayments and recoupments can occur.

This session by expert speaker Lynn M. Anderanin, CPC, CPPM, CPC-I, COSC, will provide you with samples of the different forms and other documentation that should be present in the medical record for compliance.  Lynn will also review the assignment of the proper HCPCS code and explain when is it necessary for the patient to be responsible for supplies if Medicare feels it doesn’t meet medical necessity requirements but the provider feels that it would benefit the patient.

Session Highlights:

  • Using the Pricing, Data Analysis and Coding tool for proper HCPCS code assignment
  • DME requiring a detailed written order and what should be included in this order?
  • Proof of delivery requirements and patient signature requirements
  • Modifiers used and mandated by Medicare DME coding guidelines for medical necessity
  • What is needed on your checklist to identify whether all documentation is available?
  • Should you be audited?
  • Do all of the required documentation need to be present?
  • Is it necessary that payments may have to be returned to Medicare at a financial loss to providers?

Session Snapshots:

  • Stark Law
  • CMS Program Integrity Manual – Chapter 5
  • Orders
    • Dispensing
    • Detailed written order
  • Medical Necessity statement
  • Medical records
  • Proof of delivery
  • Advance Beneficiary Notice (ABN)
  • Modifiers
    • RT/LT
    • KX
    • KT-KY
    • KT-KV
    • KW-KY
  • Coverage modifiers
  • DME terminology
  • CMS definition of Brace
  • L code reimbursement

Who should attend?

  • Managers
  • Administrators
  • Physicians
  • Physical therapists
  • Occupational therapists
  • Podiatrists
  • Coders
  • Billers
  • Orthopedics and Podiatry professionals

Order Below or Call 1-866-458-2965 Today

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About Our Speaker

Lynn Anderanin - Orthopedic Guidelines Expert for ICD 10

Lynn M. Anderanin, CPC, CPPM, CPC-I, COSC is the Sr. Director of Coding Education for Healthcare Information Services, a revenue cycle management service. She has 30 year’s experience in all areas of the physician practice specializing in Orthopedics. With the AAPC, Lynn is a national conference, workshop, and audio conference presenter and a former member of the National Advisory Board.





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