One of the most confusing things to medical billing personnel is rental modifiers. Most billers don’t know what a modifier is unless they have at least had some knowledge about rental billing. Hopefully, reading this installment, you will have a decent idea of what modifiers are, the way they work and what you have to be conscious of when you are performing your medical billing duties.
Rental products are a strange breed on the planet of Medical Billing Modifier List. Unlike any purchase item that is certainly sold and after that that’s the final from it, a rental item is similar to the gift that continues giving. This is a medical billing agencies main source of income, particularly if they actually do a lot of oxygen billing which requires patients to get an oxygen concentrator for a lot of months if not years.
For this reason, insurance carriers have to know, every step along the way, exactly how long some equipment has been rented. Why? Well, this has to do with certain regulations. See, once a specific thing has become rented a lot of months, usually 12, it then continues on what is called maintenance billing. Maintenance billing is normally cheaper than regular billing because by the time the one year have passed, the supplier from the equipment has now gotten their due profit from the item as a result of this, the insurer starts to pay less starting with month 13. What does all of this pertain to modifiers?
Medical care providers’ time is most beneficial spent on treating patients. It is actually what brings them professional satisfaction in addition to being the things they primarily went to school for. While physicians are technology-savvy, the intricate software programs used in Electronic Health Records (EHR) is best left to dedicated administrative staff. While EHRs have created greater access to patient information, the time it will take to perfect software must not subtract coming from a physician’s time treating patients. Physicians constantly absorb the newest information within their field. Innovative medical techniques tend to be more valuable to them, as well as their patients, than cutting-edge documentation requirements.
Every computer program cannot alternative to an experienced, human professional. Medical documentation specialists undergo their very own rigorous course of study plus they earn credentials to ensure they bring high quality skills to the job of translating medical documentation into industry-standard medical codes. No computer software can understand documentation the way a person can. While current programs are making great advances over time, the technology has not developed to where it is actually 100% reliable. Couple this with individual payer requirements and the advantages of oversight from a professional coding and compliance specialist become obvious.
From months one through 12, the modifier for that particular rental item is going to be one list of letters, usually beginning with the letter K. When month number 12 hits, the item will then be transferred to another status called maintenance. Although this is happening, the modifier that is stored with all the item is changed from the K modifier to something different, again, depending on the item. When the insurer sees this modifier come over on month 13, they are fully aware the item is on maintenance now pay another allowable for it. Usually, at this point, the piece also stops billing monthly. Depending on what exactly it is, it may bill every 6 months or perhaps each year.
One thing that a lot of medical billing personnel don’t understand is how this procedure happens. So how exactly does the application know when you ought to alter the modifier coming from a K to a maintenance modifier? It does this by exploring the number of rebill pages that are in the dypkxe. Every time the system bills a rental item, as it is not really a one shot deal, it generates another billing page, known as a rebill page. In case the device has billed 11 months and that’s the key, it knows after it is billing month 12 and during that time it changes the modifier AFTER it sends the month 12 bill. That is the key, to accomplish it after and NOT before. Otherwise, the piece goes on maintenance too soon. It’s a difficult process but it all happens behind the scenes. Therefore if your DME software is working properly, you shouldn’t run into any problems with your rental modifiers.