Downsize Those DSOs

HCPCS Code E0570
(Nebulizer)

Average Medicare DSO
53 days

Because a nebulizer is a capped rental item that does not require a special CMN and is rarely denied for medical necessity (C035), it is an item that should be billed and paid very quickly, said Bently Goodwin, CEO of RemitData, Memphis, Tenn. The top-performing companies in the industry are reimbursed on average in 20 days or less, he notes. “The common thread is that the need for the item is often seasonal, creating a break in need. The first problem this creates is a ‘same or similar’ denial as the patient needs the item again and gets one from a different provider,” he explains. “The second problem is created by the fact that the DMERC creates a ‘dummy’ CMN for the E0570 and then expects any bills for that patient for E0570 over the next 15 months to have a certain capped rental modifier. If the patient calls and says ‘I am not using it anymore’ and then starts using it again seven months later, you start getting CO35 denials stating that the benefit max has been reached.” In order to avoid this situation, Goodwin recommends that providers train intake staff and all other staff members who have interaction with the patient to ask if the patient has ever had this type of equipment before. Intake personnel should ask the referral source if there is any patient history that would suggest a previous use. If a patient starts reordering medications and a provider starts billing the nebulizer again, notify the DMERC that there was a break in service and bill with the appropriate modifiers, he advises.

Data represents a categorized and weighted analysis of approximately 1,077,000 Medicare paid claim lines adjudicated by the four DMERCs between Oct. 1 and Oct. 31, 2005, 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