One of the most confusing things to medical billing personnel is rental modifiers. Most billers don’t even know what a modifier is unless they have at least had some experience with rental billing. Hopefully, after reading this installment, you will have a decent idea of what modifiers are, how they work and what you have to be aware of when doing your medical billing duties.
Rental merchandise is a strange breed on the planet of CPT Modifier. Unlike a purchase item which is sold and after that that’s the conclusion of it, a rental item is kind of like the gift that continues giving. This is a medical billing agencies main source of income, especially if they are doing lots of oxygen billing which requires patients with an oxygen concentrator for a lot of months otherwise years.
Because of this, insurance carriers have to know, each step along the way, precisely how long a piece of equipment continues to be rented. Why? Well, this concerns certain regulations. See, once an item continues to be rented a lot of months, usually 12, it then goes on what exactly is called maintenance billing. Maintenance billing is usually less than regular billing because when the one year have passed, the supplier of the equipment has already gotten their due make money from the product and due to this, the insurance company starts to pay less beginning with month 13. What does all this relate to modifiers?
Healthcare providers’ time is better invested in treating patients. It is actually what brings them professional satisfaction in addition to being the things they primarily went along to school for. While physicians are technology-savvy, the intricate software applications utilized in Electronic Health Records (EHR) is better left to dedicated administrative staff. While EHRs have formulated greater usage of patient information, the time it requires to master software must not subtract from the physician’s time treating patients. Physicians constantly absorb the newest information in their field. Cutting edge medical techniques are definitely more valuable to them, and to their patients, than cutting-edge documentation requirements.
Even the best computer program cannot replacement for an experienced, human professional. Medical documentation specialists undergo their particular 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 software package can understand documentation the way in which a person might. While current programs are making great advances over time, the technologies have not yet created to where it is 100% reliable. Couple this with individual payer requirements and some great benefits of oversight from the professional coding and compliance specialist become obvious.
From months one through 12, the modifier for the particular rental item will be one group of letters, usually starting with the letter K. When month number 12 hits, the piece is then transferred to a new status called maintenance. While this is happening, the modifier that is stored with all the item is changed from the K modifier to another thing, again, depending on the item. When the insurer sees this modifier come over on month 13, they are fully aware the product is on maintenance now pay a different allowable for this. Usually, when this occurs, the item also stops billing monthly. According to what exactly it is, it may bill every six months or perhaps each and every year.
The one thing that many medical billing personnel don’t understand is how this process happens. So how exactly does the program know when you should change the modifier from a K to a maintenance modifier? It will this by looking at the number of rebill pages which can be inside the dypkxe. Every time the device bills a rental item, since it is not really a one shot deal, it produces another billing page, called a rebill page. Therefore if the system has billed 11 months and that’s the real key, it knows after it is billing month 12 and at that time it changes the modifier AFTER it sends the month 12 bill. This is the key, to do it after and NOT before. Otherwise, the product continues maintenance too early. It’s a difficult process but it all happens behind the curtain. In case your DME software program is functioning properly, you shouldn’t run into any difficulties with your rental modifiers.