Monday, March 28, 2011

DME claims submission guideline and tips

Claims/Billing

• Provider must submit claims in accordance with the Healthcare Common Procedure Coding System (HCPCS) and national industry standards.

• Providers can only bill for the actual number of medically necessary units dispensed/delivered to a recipient, regardless of the number of units allowed by policy and/or prior authorization.

• Providers must bill their usual and customary charges.

Rental Items
Rates identified in the DMEPOS Fee Schedule for rental items (modifier code RR) are calculated as a monthly rate and are to be billed at monthly intervals beginning with the date item was dispensed/delivered to recipient. The exceptions to this are for codes E0202 and E0935, which are daily rates.

Special Instructions for Common Products and Services

For all DME items, refer to Nevada Medicaid DME policy in MSM Chapter 1300. Claims
must include the appropriate physician’s diagnosis code in accordance with policy.

Bundled Services

For any HCPCS code description in which various components are identified, the components may not be billed separately. The Nevada Medicaid rate includes all items in the description.

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