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Monthly Supply Billing

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Michelle_Eskelsen

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As a DME biller, we have quite a few monthly patients for trach, ostomy, enteral nutrition etc. The issue I run across mainly is not getting paid for a crossover claim. I understand that billing cycles cannot run into each other but my question is how to counter that? Do I need to make sure my DOS has an end DOS? Most of our claims go out with the DOS as both beginning and end DOS the same..I am thinking this may be the issue but I cannot find any documentation anywhere suggesting that may be the case. All I know for sure is feeding kits and nutrition need span dates and that has been rectified in my software, just not sure about other supplies, especially for trachs. Any input is greatly appreciated!
Michelle
 
Michelle_Eskelsen said:
As a DME biller, we have quite a few monthly patients for trach, ostomy, enteral nutrition etc. The issue I run across mainly is not getting paid for a crossover claim. I understand that billing cycles cannot run into each other but my question is how to counter that? Do I need to make sure my DOS has an end DOS? Most of our claims go out with the DOS as both beginning and end DOS the same..I am thinking this may be the issue but I cannot find any documentation anywhere suggesting that may be the case. All I know for sure is feeding kits and nutrition need span dates and that has been rectified in my software, just not sure about other supplies, especially for trachs. Any input is greatly appreciated!
Michelle
Click to expand...
TRACH SUPPLIES I DONT BELIEVE NEED SPAN DATES
IF YOU BILL ENTERAL NUTRITION I GOT A QUESTION FOR YOU THOUGH. AS A DME SUPPLY STORE AND NOT A PHARMACY HAVE YOU BEEN ABLE TO GET THE FORMULA PAID BY MEDICAID PLANS FOR CROSSOVER CLAIMS. IN CA MEDICAID HAS A DIVISION CALLED THE RX DIVISION WHICH ALL DRUGS ARE SUPPOSSED TO BE BILLED THRU. THEY INCLUDE THE FORMULA CODES AS DRUGS. THEY DENY THEIR PORTION OF THOSE CODES FOR CROSSOVER CLAIMS STATING THAT THEY HAVE TO BILLED THRU MEDICAL RX DIVISION BUT ONLY PHARMACIES CAN SET UP TO BILL THRU MEDICAL RX SO WE JUST DONT GET PAYMENT FOR THE SECONDARY PORTION OF ALL FORMULA CODES
 
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