| Average Medicare DSO (Days Sales Outstanding) By Product Category | DME (E0260, K0001, E0143, etc.) | 62 |
| Respiratory (E1390, J7619, E7619, etc.) | 47 | |
| Rehab (K0011, K0108, E0010, etc.) | 86 |
HCPCS Code A4253
(diabetic strip)
Average Medicare DSO
49 days
The diabetic strip's average DSO of 49 days is not bad. But it is worth noting that these claims can be affected by denials if the dates of service on the claim are spanned incorrectly. The end date must always reflect the time period during which the supplies will be used. For example, from April 16, 2006, through May 15, 2006, the supplies should last the patient 30 days based on how frequently they are testing.
Another thing that can cause the diabetic strip DSO to fluctuate is Medicare's request to see additional documentation on claims that are over the limit of 100 strips per month for insulin-treated patients and more than 100 strips every three months for non-insulin-treated patients. The physician order must specify that the patient requires testing more frequently, and it must document why the patient requires additional testing. New documentation must be available at least every six months if the patient regularly requires supplies greater than the set limit. The supplier also must have documentation that the patient is actually testing at the higher frequency.
The provider is responsible for obtaining information to document the patient's need to test more frequently than the policy states including:
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Medical records prior to the claim date of service (treating physician's office notes, treating physician's glycemic goals for the patient, frequency of physician visits or phone contacts, documentation of diabetes-related complications, documentation of patient self-adjusting medication dosage based on self testing results and frequency of hypoglycemia)
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Actual test results (lab tests and patient testing log)
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Oral diabetes medications or insulin injections (name, dosage and frequency of all drugs)
Medicare usually will pay for the extra strips based on the modifier attached to the HCPC and additional information supplied in the HAO record. However, these claims can be chosen for a post-pay audit and claim development. The bottom line: Have the necessary documentation in your files prior to billing the 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 1.3 million Medicare paid claim lines adjudicated by the four DMERCs between May 1, 2006, and May 31, 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.
