Wiki DME Billing/POS

[littlehaskett04]

Hey, I'm new to DME so i'm unsure of their billing guidelines. I'm coming across some POS denials, we provide equipment to ASC, typically use POS 24 -ASC Center, however, in a round about way, BCBS hinted that our POS is incorrect, and we should be using POS 22 (outpatient)
Does anyone know proper DME billing procedures?
Thanks.

 

[creinhardt]

While your POS may be an issue the cause may be with the ASC. Most BCBS Plan ASC contracts include equipment cost/rental in the payments made to the ASC. Your claim may be stopped due to the POS, because payment for your services was made to the ASC.

This is a big issue with compression cuffs, placed on the patient during surgery to reduce the risk of blood clots, and being separatly billed by DME companies. Payment for this device/service is part of the global payment made to the ASC.

That said, there are 39 BCBS companies and each has their own payment/benfit structue.

 

[littlehaskett04]

Thanks Creinhardt,

That is exactly what we are biling for, from an ethical stance, does it hurt to bill the POS 22 instead of the 24? Or does it even matter?

The majority of our ASC centers are out of state, we also find it difficult to determine if we submit locally or directly to the plan, inwhich the surgery was preformed.

BCBS just seems to be a trouble for us, and its such a major carrier of ours. Seems we write off balance each time.