Normally we look at claim denials, but there are other reasons why HME providers don't receive their money.

Normally we look at claim denials, but there are other reasons
why HME providers don't receive their money. One of them comes in
the form of a post-payment review, a request from the DME MAC
Medical Review team to prove that the claim the provider was paid
is compliant with Medicare coverage policies. If it is not,
Medicare will identify overpayments and recover the money that was
reimbursed. Providers who consistently do not provide documentation
to support their claims may be referred to the Office of Inspector
General for investigation and/or sanctions.

Cigna Government Services, the DME MAC for
Jurisdiction C, recently completed a claim review that revealed
widespread deficiencies in proof-of-delivery documentation. Some of
the issues Cigna identified include:

Lack of delivery documentation;

  • Date of delivery not listed;

  • Missing or illegible signature of person accepting delivery;

  • Designee relationship to beneficiary not documented; and

  • Incomplete description of the item(s) delivered.

    Proof of delivery is required in order to verify that the
    beneficiary received the DMEPOS billed. Proof-of-delivery
    documentation must be maintained in the provider's files for seven
    years.

    If you deliver the DMEPOS directly to the beneficiary, a signed
    and dated delivery slip offers proof of delivery if it contains
    sufficient detail to identify the items and verify that they were
    correctly coded. The delivery slip should list the beneficiary's
    name as well as the following information for each item
    delivered:

    The quantity delivered;

  • A detailed narrative description of the item;

  • The brand name (manufacturer);

  • The model name or number (if applicable); and

  • The serial number (if available).

    The date listed on the delivery slip should be the date the
    beneficiary or designee received the item.

    When utilizing a shipping service or mail order, an example of
    proof of delivery is the service's tracking slip plus your own
    shipping invoice. If possible, your records should also include the
    delivery service's package identification number for the package
    sent to the beneficiary. The shipping service's tracking slip
    should reference each individual package, the delivery address, the
    corresponding package identification number given by the shipping
    ervice and, if possible, the date delivered.

    You can also utilize a return postage-paid delivery invoice from
    the beneficiary or designee as a form of proof of delivery. The
    descriptive information concerning the DMEPOS item (i.e., the
    beneficiary's name, the quantity, detailed description, brand name
    and serial number) as well as the required signatures from either
    the beneficiary or the beneficiary's designee should be included on
    this invoice as well.

    Regardless of the method used to document proof of delivery, the
    beneficiary or a designee must sign and accept delivery of the
    item(s). Providers, their employees or anyone else having a
    financial interest in the delivery of the item are prohibited from
    signing and accepting an item on behalf of a beneficiary.

    The relationship of the designee to the beneficiary must be
    noted on the delivery slip (i.e., spouse, neighbor, etc.). The
    signature of the designee should be legible. If the signature of
    the designee is not legible, the provider (or the shipping service)
    should note the name of the designee on the delivery slip.

    Even though this probe was done in Jurisdiction C, all HME
    providers should make sure their proof of delivery is in accordance
    with Medicare guidelines.

    Sarah Hanna is a reimbursement consultant and vice president of
    ECS Billing & Consulting, Tiffin, Ohio, and specializes in
    proper billing protocols, Medicare coverage guidelines and billing
    office procedures. You can reach her at 419/448-5332 or sarahhanna@bright.net.

    Of 6,612,408 claims adjudicated by the four DME MACs and
    processed for RemitDATA customers in Q4 2008, there were 1,143,760
    total denials. Source: RemitDATA, 866/885-2974,
    www.remitdata.com