| Average Medicare DSO (Days Sales Outstanding) By Product Category | DME (E0260, K0001, E0143, etc.) | 61 |
| Respiratory (E1390, J7619, E7619, etc.) | 49 | |
| Rehab (K0011, K0108, E0010, etc.) | 88 |
HCPCS Code A7034
(Nasal interface, mask or cannula used with positive airway
pressure device)
Average Medicare DSO
61 days
Medicare patients are limited to receiving one A7034 every three months. If a patient receives more than that, be sure to cover your bases, because the claim will be denied, and it will need to go through the appeals process.
Have the patient sign an Advanced Beneficiary Notice, which will allow you to bill the patient when the claim is denied. Gain the specific information regarding why the patient required the extra mask/cannula. This information should be in your files prior to billing the claim to allow you to move faster on the denial.
If the denial is one that you feel is worth going to redetermination, then move forward; if not, you are free to bill the patient with the patient-signed ABN on file, whether it was an assigned or non-assigned claim. Remember, with the ABN, even if the redetermination is denied you can still bill the patient. The A7034 also requires the KX modifier for billing, so make sure it is included with your claim.
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.
Data represents a categorized and weighted analysis of approximately 1.07 million Medicare paid claim lines adjudicated by the four DMERCs between April 1, 2006, and April 30, 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.
