Billing for DME and Home Infusion: Tips for Success Now and into the New Year
By: Nicole Zurawski, Mediware Reimbursement Services
Although the new year is not yet here, now is the time to plan ahead to ensure that you and your billing team are prepared for unique billing processes that may be required at year-end. If you are proactive and ensure that your billing team is doing benefit verification checks and understanding payer guidelines prior to January, you may be able to avoid some of the potential problems listed below.
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Here are three tips to help DME and home infusion billers prepare for creating claims that cross over “years” or that are in the new calendar year:
- Know which payers require split claims. Check your payers’ billing guidelines because some require that claims that have a span date cannot have service dates that cross over calendar years. If so you may need to splityour charges during your billing process before the claims are created and bill them on separate claims. Claims that should be split into separate calendar years but aren’t will likely be denied, which means a decrease in cash flow and an increase in DSO.
- Verify benefits. At the start of each year, most insurance company deductibles reset, and any change(s) in benefits are implemented. Therefore, verify policy information prior to claim submissions for the 2017 coverage period.
- Determine if policy ID numbers have changed. If there are changes to policy ID numbers, these will likely take effect in January, and these changes will affect prior authorizations. If any of your accounts have policy ID number changes, determine if these accounts have active prior authorizations for services because you will need to ask that the authorization numbers be transferred to the new policy ID numbers. That way, you will be able to continue to provide and bill for services under the prior authorization you already have on file.
Managing the details of year-end and new-year billing can be challenging. If you need assistance with your DME and home infusion billing, Mediware’s reimbursement team can help you grow your collections. With more than 60 experts on staff, Mediware Reimbursement Services can take your billing headaches away!