1. C

    Question DME medicaid denials

    We have been receiving denials from our medicaid plans on our DME's such as L1902 and L3908, stating it is included in a global surgery package. We have never had this issue before. I have tried looking up changes to billing DME's but cannot find anything. I called the insurance and they can...
  2. J

    Question Walking boot for ankle sprain denied as "routine"?

    Hello, We gave a patient a Walking Boot with the sprained ankle diagnosis and UHC is denying this as "not covered when considered routine". I am attempting to appeal this but I'm not sure why this would be even considered routine on their part? Has anyone had experience with this? Thank you !
  3. L

    Billing Medicare DME outside of my jurisdiction.

    Hi all. I have a few Medicare recipients that are snow birds. My DME claims are getting denied because I am in JC and their policies are in JA. Medicare(CGS) told me to bill to that jurisdiction. I have tried to bill the jurisdiction they are in but get denied their as well. Any advice on...
  4. W

    DME Delivery Address Question

    Hello, I am wondering if there is CMS regulation regarding DME and the address it is delivered to, in accordance with the patient's health insurance. For example: A Back Brace is ordered for a patient and delivered to 15 Main St, Anywhere, USA, but according to the patient's insurance, their...
  5. D

    DME Coding/Reimbursement - A7020 and LCD L33795

    Hello! I'm looking for some insight from anyone with experience billing A7020 to Medicare for mechanical in-exsufflation devices ... the LCD is quite vague regarding accessories/supplies, but I am wondering if anyone has experienced difficulties or limitations billing A7020 for replacement...
  6. M

    Billing DME

    I'm pretty new to using HCPCS level 2 codes. The code E0114 (crutches) has an indicator that says "Bill DME MAC" can anyone tell me what this means? Can I bill this to Medicaid?
  7. A

    Billing for shoes and inserts to Medicare (ING)

    Hi everyone! I am trying to bill to CGS Medicare for DME. The doc did 1 pair of shoes A5500 and 3 pairs of inserts A5512 for a diabetic patient. I am new to DME billing and I heard so many different versions how I supposed to do it. Previously I billed A5500 x 1 and A5512 x 3 and haven't heard...
  8. C

    MediCal paying for services for loss and damaged item?

    Can Medi Cal be billed for the services when the provider is seeing a patient for a loss or damaged replacement DME?
  9. C

    MediCal paying for services for loss and damaged item?

    Can Medi Cal be billed for the services when the provider is seeing a patient for a loss or damaged replacement DME?
  10. N

    United Healthcare DME Supply Denials

    Our office is going crazy with these United Healthcare (Medicare Advantage Program) denials! I am hoping that someone else might be going through the same difficulty. We are a 3rd Party supplier/billing/coding company for DME supplies in nursing homes - generally when a patient finishes their...
  11. T

    Brightree Experienced Intake/Biller Needed for DME offices

    I am having difficulty finding a Medical Biller with Brightree experience. If you know of someone, please send them to me for two full time opportunities in the Donelson and Hermitage area. Thank you so much, Michelle Thomas 615-316-0755
  12. M

    General Ortho Surgery Charge Posting

    Hello all, I have recently made the move from a pediatrics office to a Pediatrics Orthopedics specialist and while I am familiar with office visits, post-op visits, xrays, & casting. I have NO experience with surgery charges and DME billing. Currently someone else is billing all of our...
  13. N

    DME - Suction Catheter non-published MUE

    We have a new developmental center coming onto our DME service (we are 3rd party supplier and biller). They have 4 patients using 12 suction cathether kits per day. The LCD has no specific information on covered amounts, simply that as long as there is a covered suction pump, you can supply and...
  14. O

    Durable Medical Supplies

    Our small clinic is looking to offer DME (splints, braces, crutches etc.) for our patients to walk out of the office with. Is it legal to bill different insurance carriers, different prices based on their reimbursement? Thanks you.
  15. D

    Billing DME to Medicare Without Medicare Contract

    After 26 years in working for physicians' offices, I started working for a DME business late last summer. We just became CHAP accredited and are filling out a Medicare Provider application. My question is - If we see a patient who has Medicare primary, can we bill Medicare DMERC (ie., before...
  16. D

    Humana and DMEs

    Please help. My podiatry practice bills out for DME products such as post-op shoes and pneumatic walkers. Humana has lately been denying them for incorrect modifiers. We have used LT, RT, Medicare modifiers, any modifiers we can find to try to get these paid for. Has anyone else had this...
  17. D

    RAC/Braces supplied to IP

    We've been RAC'd for knee braces supplied to inpatient's. I know the hospital can't get paid for DME for an inpatient - but shouldn't we be able to be reimbursed? What place of service should have been used? Thanks!
  18. M

    Dme & icd 10

    Does anyone know anything about DME billing and what it will do to/for DME? I work for an Optician/Optometerist office and my boss (optician) and I are very interested in knowing what the code changes hold, and how different the billing will be. Any information would be appreciated! Thanks...
  19. M

    DME Oxygen Supplies

    We recently started providing oxygen to patients in home. Some are rentals others are owned. I am confused as to what we can charge for when equipment is rented and owned. I am being told to bill for every little thing we use including tank refills, adapters, peep valves, filter kits, airway...