One of the most confusing things to medical billing personnel is rental modifiers. Most billers don’t even know what a modifier is unless they have at least had some knowledge of rental billing. Hopefully, after looking at this installment, you will have a decent concept of what modifiers are, how they work and what you have to be aware of when doing your medical billing duties.
Rental merchandise is an unusual breed on the planet of CPT Modifier. Unlike an order item that is sold and then that’s the end of it, a rental item is kind of like the gift that keeps on giving. This is a medical billing agencies main revenue stream, particularly when they are doing lots of oxygen billing which requires patients to get an oxygen concentrator for a lot of months if not years.
Because of this, insurance companies have to know, each step along the way, precisely how long a piece of equipment continues to be rented. Why? Well, this has to do with certain regulations. See, once a specific thing has become rented numerous months, usually 12, it then goes on what exactly is called maintenance billing. Maintenance billing is usually less than regular billing because once the 12 months have passed, the supplier in the equipment has already gotten their due benefit from the item and due to this, the insurer actually starts to pay less beginning with month 13. Exactly what does all of this pertain to modifiers?
Health care providers’ time is better spent on treating patients. It is what brings them professional satisfaction as well as being the things they primarily went to school for. While physicians are technology-savvy, the intricate software applications found in Electronic Health Records (EHR) is better left to dedicated administrative staff. While EHRs have created greater usage of patient information, the time it requires to learn software should never subtract coming from a physician’s time treating patients. Physicians constantly absorb the most recent information inside their field. Cutting edge medical techniques tend to be more valuable to them, and also to their patients, than cutting-edge documentation requirements.
Even reliable computer program cannot replacement for an experienced, human professional. Medical documentation specialists undergo their very own rigorous length of study and they also earn credentials to ensure they bring high quality skills to the job of translating medical documentation into industry-standard medical codes. No software package can understand documentation just how a person can. While current programs are making great advances through the years, the technology has not yet developed to where it is actually 100% reliable. Couple this with individual payer requirements and the advantages of oversight from a professional coding and compliance specialist become obvious.
From months one through 12, the modifier for the particular rental item will likely be one set of letters, usually starting with the letter K. When month number 12 hits, the piece will be transferred to a new status called maintenance. Although this is happening, the modifier that is stored with all the item is changed from a K modifier to something different, again, depending on the item. When the insurer sees this modifier come over on month 13, they understand the item is on maintenance and today pay another allowable because of it. Usually, when this happens, the product also stops billing monthly. Based on what it is, it could bill every half a year as well as each and every year.
The thing that a lot of medical billing personnel don’t understand is the way this procedure happens. So how exactly does the application know when you should modify the modifier coming from a K to a maintenance modifier? It will this by studying the variety of rebill pages which are within the dypkxe. Each and every time the device bills a rental item, because it is not really a one shot deal, it generates another billing page, known as a rebill page. In case the device has billed 11 months and that’s the real key, it knows when it is billing month 12 and at that time it changes the modifier AFTER it sends the month 12 bill. This is the key, to do it after and never before. Otherwise, the item goes on maintenance too soon. It’s a difficult process nevertheless it all happens behind the curtain. Therefore if your DME software program is functioning properly, you shouldn’t encounter any problems with your rental modifiers.