Just about 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 experience with rental billing. Hopefully, after looking at this installment, you will have a decent idea of what modifiers are, the way they work and what you have to be aware of when you are performing your medical billing duties.
Rental products are an unusual breed in the world of Medical Billing Modifier List. Unlike an order item which is sold then that’s the end of it, a rental item is kind of like the gift that continues giving. It really is a medical billing agencies main revenue stream, especially if they do plenty of oxygen billing which requires patients to have an oxygen concentrator for many months otherwise years.
For this reason, insurance companies have to know, each step as you go along, just how long some equipment has become rented. Why? Well, this has to do with certain regulations. See, once an item continues to be rented so many months, usually 12, it then continues what is called maintenance billing. Maintenance billing is usually cheaper than regular billing because when the twelve months have passed, the supplier of the equipment has now gotten their due benefit from the item and because of this, the insurance company actually starts to pay less beginning with month 13. Precisely what does this pertain to modifiers?
Medical care providers’ time is best spent on treating patients. It is what brings them professional satisfaction as well as being what they primarily visited school for. While physicians are technology-savvy, the intricate software packages used in Electronic Health Records (EHR) is better left to dedicated administrative staff. While EHRs have formulated greater access to patient information, the time it takes to master software should not subtract from a physician’s time treating patients. Physicians constantly absorb the latest information inside their field. Innovative medical techniques are more valuable for them, and to their patients, than cutting-edge documentation requirements.
Even reliable computer program cannot alternative to an experienced, human professional. Medical documentation specialists undergo their own rigorous course of study and they earn credentials to ensure they bring high quality skills for the job of translating medical documentation into industry-standard medical codes. No software program can understand documentation the way a person can. While current programs are making great advances over the years, the technologies have not yet developed to where it really 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 your particular rental item will be one group of letters, usually starting 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 certainly stored with all the item is changed coming from a K modifier to something else, again, depending on the item. When the insurer sees this modifier come over on month 13, they understand the product is on maintenance now pay another allowable for this. Usually, at this point, the product also stops billing monthly. Based on what exactly it is, it could bill every half a year or even each and every year.
The thing that many medical billing personnel don’t understand is how this process happens. So how exactly does the program know when to change the modifier from a K to a maintenance modifier? It can this by studying the variety of rebill pages which can be within the dypkxe. Each and every time the program bills a rental item, because it is not a one shot deal, it generates another billing page, called a rebill page. Therefore if the program has billed 11 months and that’s the real key, it knows when 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 piece continues maintenance too early. It’s a tricky process nevertheless it all happens behind the scenes. So if your DME software is working properly, you shouldn’t encounter any issues with your rental modifiers.