ANSWERS TO YOUR INDUSTRY QUESTIONS What are some of the most common billing mistakes HME providers make, and how can we avoid them?

HOME MEDICAL EQUIPMENT providers commonly make several types of billing mistakes-and each can spell the difference between being reimbursed fairly or not at all. Here are five errors I see regularly, as well as suggestions for avoiding them.

1 Taking too long to submit a claim. "Too long" is defined as any period greater than 11 days (the industry standard for "unbilled" days) from the service date. The reasons that it could take longer include poor patient/order intake, delayed certificate of medical necessity production, poor follow-up on CMNs sent to doctors and incomplete coverage screening, which ensures patients meet the coverage criteria before services are rendered.

2 Assuming that Medicare Part B patients will pay their own copay or deductibles. More than 80 percent of Medicare patients have supplemental insurance, which pays for the copay and deductibles. Assuming a patient is paying privately only frustrates patients, delays billing to the correct payer and forces unnecessary adjustments in your billing system to move money around to the right payer.

3 Calling the customer service unit of the Durable Medical Equipment Regional Carrier to ask a question. You should call the DMERC to ask a question only after you have looked for the answer in the supplier manual and newsletters. Suppliers always complain about the quality and accuracy of the information received from DMERC staff. However, those same suppliers have an obligation to research their questions in the DMERC manuals and newsletters before asking questions verbally. Suppliers also have an obligation to document whom they spoke to, the date and what they were told.

4 Not responding properly to claim denials. Claim denials use either words or codes to explain why the claim was denied. Looking at the actual denial reason is one of the most important tools to properly address the problem with the claim. Furthermore, tracking denials by payer and by reason results in an important management tool that every supplier should have.

5 Holding rental claims while the patient makes a purchase option. Medicare requires a purchase option be given to the patient in the 10th month of rental. However, Medicare will continue to pay rentals up to the 12th month while the patient makes up his or her mind. Thus, rental billing should continue during the purchase-option process. By the 12th rental claim, the decision-making process must be complete, which results in a certain modifier attached to the HCPCS code.

For more on billing errors, see Final Analysis on page 82.

-Answered by Lisa Thomas-Payne, Medical Reimbursement Systems, 4425 Juan Tabo N.E., Suite 110, Albuquerque, NM 87111; 505/255-0004; fax: 505/255-0550; e-mail: lthomasp@aol.com