Medicare Compliance & Reimbursement

...but there must be a prescription for DME.

A durable medical equipment company need not be a participating Blue Cross provider to obtain a Blue Cross billing number--and getting one can help the company operate more efficiently.

That was the message June Levey, president of Indianapolis-based DME Claims Services Corp., delivered during a recent teleconference titled “8 Easy Ways to Master DME Billing.”

“You’ll get your claims processed much faster, even though oftentimes they’ll be paid to the patient,” Levey said. “You’ll just need to bill the patient.”

Without a billing number from the health insurance giant, a DME supplier can’t send a claim electronically, Levey noted.
 
The application form for a Blue Cross billing number varies from state to state, but they can be as long as 35 pages, Levey observed. “I still encourage providers to go through it,” Levey said. “Usually there’s more instruction in there than actual stuff you have to fill out.”

Even if you do have a Blue Cross billing number and file a claim electronically, keep in mind that Blue Cross requires a prescription for DME, Levey noted.

“So you need to find out from your local Blue Cross the correct ways to submit paper documentation to be attached to your electronic claim,” she advised.

Furthermore, don’t forget to put the electronic invoice number assigned by Blue Cross on the additional paper documentation the local provider requests.

Providers that don’t currently have a Blue Cross number should put “non-par” (for non-participating) at the bottom of the claim form. It should go in the space for the provider number, where a provider would normally insert its tax identification number. Using a tax ID number there can be a problem as it will cause Blue Cross to check whether a provider has “participating provider” status--and that can lead to payment nightmares.

“We’ve actually had them find a par provider who has a similar name and pay them,” Levey warned. “If you put ‘non-par,’ they won’t spend that time looking and send the payment to the wrong provider.”