| Average Medicare DSO (Days Sales Outstanding) By Product Category |
DME (E0260, K0001, E0143, etc.) | 68 |
| Respiratory (E1390, J7619, E7619, etc.) | 48 | |
| Rehab (K0011, K0108, E0010, etc.) | 88 |
HCPCS Code E0163
(Commode chair, stationary, with fixed arms)
Average Medicare DSO
78 days
The E0163, the most common commode dispensed, is a very simple piece of equipment. Although one would wonder why its DSO is higher than average for DME, there is an explanation.
One reason for the high DSO is that this code requires a KX modifier, which must be added to the HCPC prior to sending the claim. If the KX modifier is not attached to the E0163, the claim will be denied with the CO50 denial code (non-covered because it is not deemed medically necessary). If the claim is denied with this code, you then have to send the claim to redetermination. It takes 45 to 60 days from the date Medicare receives the redetermination request and additional documentation to make a decision on payment or denial. The majority of these claims will be paid based on the Physician Order and the patient's meeting the coverage criteria from information that is sent along with the redetermination request.
Make sure it is well documented that the patient is “physically incapable of utilizing regular toilet facilities” in accordance with the criteria set forth by CMS in your DMERC manual. This can be documented by requiring the patient or responsible party to sign a statement on the delivery ticket (or on another form) that the patient has no toilet facilities in the home or is confined to a room with no toilet on that level of the home. This also can be documented on the written Physician Order. At the very least, documenting that the patient or responsible party was asked these questions and the patient met the coverage criteria is required. Include the name of the person you confirmed this with, the date and time of the conversation and the employee's name who was involved.
Data represents a categorized and weighted analysis of approximately 808,000 Medicare paid claim lines adjudicated by the four DMERCs between Feb. 1, 2006, and Feb. 28, 2006, and processed for RemitDATA customers. Figures reflect the average number of days elapsed from date of service to Medicare check issue date. Source: RemitDATA, 866/885-2974, www.remitdata.com
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. She can be contacted at 419/448-5332 or sarahhanna@bright.net.
