Probably the most confusing things to medical billing personnel is rental modifiers. Most billers don’t know what a modifier is unless they have at least had some knowledge about rental billing. Hopefully, after reading this installment, you will have a decent concept of what modifiers are, how they work and what you have to be mindful of when performing your medical billing duties.
Rental items are a strange breed on the planet of Medical Billing Modifier List. Unlike a purchase item which is sold then that’s the conclusion of this, a rental item is kind of like the gift that keeps on giving. This is a medical billing agencies main income source, especially if they actually do plenty of oxygen billing which requires patients with an oxygen concentrator for many months otherwise years.
Because of this, insurance carriers need to know, every step in the process, just how long some equipment has been rented. Why? Well, this concerns certain regulations. See, once a specific thing has been rented numerous months, usually 12, it then goes on what exactly is called maintenance billing. Maintenance billing is normally less than regular billing because when the twelve months have passed, the supplier from the equipment has now gotten their due profit from the piece as a result of this, the insurer starts to pay less starting with month 13. What does all of this pertain to modifiers?
Health care providers’ time is most beneficial invested in treating patients. It really is what brings them professional satisfaction as well as being what they primarily went to school for. While physicians are technology-savvy, the intricate software programs found in Electronic Health Records (EHR) is best left to dedicated administrative staff. While EHRs have formulated greater usage of patient information, enough time it requires to master software should never subtract from the physician’s time treating patients. Physicians constantly absorb the newest information within their field. Leading edge medical techniques tend to be more valuable to them, as well as their patients, than cutting-edge documentation requirements.
Even the best computer program cannot substitute for an experienced, human professional. Medical documentation specialists undergo their particular rigorous span of study plus they earn credentials to ensure that they bring top-notch skills for the job of translating medical documentation into industry-standard medical codes. No software program can understand documentation the way in which a person can. While current programs have made great advances through the years, the technology has not created to where it really is 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 that particular rental item will likely be one set of letters, usually starting with the letter K. When month number 12 hits, the item is then transferred to a different status called maintenance. While this is happening, the modifier which is stored using the item is changed from a K modifier to another thing, again, depending on the item. When the insurer sees this modifier come over on month 13, they understand the item is on maintenance and now pay an alternative allowable for this. Usually, when this occurs, the piece also stops billing monthly. Based on what it is, it could bill every half a year as well as every year.
The thing that most medical billing personnel don’t understand is just how this procedure happens. How exactly does the program know when you should modify the modifier from a K to your maintenance modifier? It can this by exploring the variety of rebill pages that are inside the dypkxe. Each and every time the program bills a rental item, as it is not a one shot deal, it creates another billing page, referred to as a rebill page. So if the device has billed 11 months and that’s the true secret, it knows after it is billing month 12 and at that time it changes the modifier AFTER it sends the month 12 bill. Which is the key, to accomplish it after and never before. Otherwise, the item continues maintenance too soon. It’s a tricky process however it all happens behind the curtain. In case your DME application is working correctly, you shouldn’t encounter any problems with your rental modifiers.