One of 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 experience with rental billing. Hopefully, after reading this installment, you will have a decent idea of what modifiers are, the way they work and what you have to be mindful of when doing your medical billing duties.
Rental items are a strange breed on the planet of CPT Modifier. Unlike an order item that is sold and then that’s the conclusion from it, a rental item is a lot like the gift that keeps on giving. It really is a medical billing agencies main source of income, particularly if they are doing a lot of oxygen billing which requires patients with an oxygen concentrator for many months if not years.
Due to this, insurance carriers have to know, each step as you go along, just how long some equipment continues to be rented. Why? Well, this concerns certain regulations. See, once a specific thing has been rented a lot of months, usually 12, it then continues what exactly is called maintenance billing. Maintenance billing is normally cheaper than regular billing because once the 12 months have passed, the supplier from the equipment has already gotten their due make money from the item and due to this, the insurance company starts to pay less beginning from month 13. Exactly what does all of this pertain to modifiers?
Healthcare providers’ time is most beneficial used on treating patients. It is actually what brings them professional satisfaction as well as being what they primarily went to school for. While physicians are technology-savvy, the intricate software packages found in Electronic Health Records (EHR) is better left to dedicated administrative staff. While EHRs have formulated greater usage of patient information, time it requires to learn software must not subtract from the physician’s time treating patients. Physicians constantly absorb the latest information within their field. Leading edge medical techniques are definitely more valuable in their mind, and also to their patients, than cutting-edge documentation requirements.
Every computer program cannot substitute for a skilled, human professional. Medical documentation specialists undergo their own rigorous length of study and they earn credentials to ensure they bring high quality skills for the job of translating medical documentation into industry-standard medical codes. No software package can understand documentation the way an individual can. While current programs have made great advances through the years, the technologies have not even created to where it is 100% reliable. Couple this with individual payer requirements and the benefits 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 list of letters, usually starting with the letter K. When month number 12 hits, the item is then transferred to a different status called maintenance. Although this is happening, the modifier that is certainly stored with all 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 know the piece is on maintenance now pay another allowable for this. Usually, when this occurs, the item also stops billing monthly. Depending on what exactly it is, it could bill every six months or even every year.
One thing that many medical billing personnel don’t understand is just how this process happens. How exactly does the program know when you ought to alter the modifier from a K to a maintenance modifier? It can this by looking at the variety of rebill pages which are inside the dypkxe. Each time the system bills a rental item, as it is not really a one shot deal, it produces another billing page, known as a rebill page. In case the system 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. Which is the key, to accomplish it after rather than before. Otherwise, the product goes on maintenance too early. It’s a difficult process however it all happens behind the scenes. Therefore if your DME software is functioning properly, you shouldn’t run into any issues with your rental modifiers.