Optometry Coding & Billing Alert
Fix Errors Before They Derail Your DMERC Claims
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Be sure to inform Medicare beneficiaries of the supplier standards
Dispensing vision supplies in your office can be convenient for your patients and profitable for your practice--if you stay on top of how your DMERC wants its claims filled out.
Check your CMS-1500 form for these common errors that lead to DMERC denials, says Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va:
- Item 11 (Insured's policy group or FECA number): If Medicare is the primary insurance, enter -NONE.-
- Item 14 (Date of current illness [first symptom]): Enter the date of the cataract surgery.
- Items 17 (Name of referring physician or other source) and 17a (ID number of referring physician): Enter the name and unique physician identification number (UPIN) of the doctor who prescribed the lenses.
- Item 19 (Reserved for local use): Enter the date of the surgery, and which eye was operated on.
- Item 21 (Diagnosis or nature of illness or injury): For post-cataract glasses, the ICD-9 code in most cases will be V43.1 (Organ or tissue replaced by other means; lens [pseudophakia]).
- Item 24a (Date of service): Enter the date you dispense the glasses. DMERC Palmetto warns, -Billing for items prior to receipt by the beneficiary may be considered fraudulent billing.-
- Item 24b (Place of service): The POS should be where the beneficiary is residing, not the office. If the patient lives at home, the POS would be 12 (home), not 11 (office).
- Item 33 (Physician's billing name, address -): Enter your information here, along with the 10-digit NSC number you were issued by the National Supplier Clearinghouse (NSC). Your name and address also go in Item 32 (Name and address of facility where services were rendered).
- Don't miss: You must also inform the Medicare beneficiary of the CMS DMEPOS Supplier Standards, Wimbish says. The NSC provides forms you can download to give to your patients.
Visit www.palmettogba.com and click the -National Supplier Clearinghouse- link under -Other Partners.-
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