Are You Familiar With The Latest HMSA DME Billing Guidelines Updates In 2020?

Undoubtedly, innovation is the only secret to the sustainability of any business. Similarly, the reason behind the rapid growth of the healthcare industry is also fast-pacing innovation.

Modern healthcare facilities have created a competitive-edge to provide quality care services to their patients. For this purpose, a major portion of healthcare providers is using Durable Medical Equipment (DME).

Before diving into further details, let’s first probe into the introduction of DME.

Durable Medical Equipment:

If a healthcare practitioner uses any medical equipment to deliver therapeutic benefits to a patient anywhere ( i.e. home) due to any medical condition then it is called durable medical equipment.

Suitable Medical Coding Classification:

When it comes to DME billing services then practitioners should be careful about the use of appropriate HCPCS modifiers and medical codes. Most importantly, they should use the latest medical coding specifications that are included in the ICD-10 code classification system.

Durable medical equipment is used for the treatment of a wide range of medical conditions such as; breast pumps, insulin pumps, pulse oximeters and any other kind of equipment that is used for the patient care services suffering from particular medical conditions.

Those medical pharmacies that participate with HMSA’s medical plan generally distribute small DMEs i.e. glucometers, walkers, braces, nebulizers etc.

Healthcare providers usually use this equipment to serve some medical purpose and they can also be easily used at home or any other place.

Doctors and medical providers prescribe one or another type of DME to the patients but they also have to abide by certain rules and policies.

Especially, they should pay attention to fine details during DME billing services. For this purpose, practitioners should encourage their front desk staff to collect useful information that describes all the data about the devices that are used as durable medical equipment.

Also, suppliers should make sure that their knowledgeable medical billing staff has essential expertise to use appropriate  Healthcare Common Procedure Coding System (HCPCS) codes and modifiers.

Your billing staff should also consider the significance of various codes, policies, and rules of law that are defined under the definition of HCPCS coding classification system. After following the complete set of protocols, healthcare practitioners prepare medical bills to charge for the use of this technology.

Moreover, medical billing experts should use the latest classification of ICD-10 coding system to indicate a medical condition that is the actual reason behind the use of DME.

Also, physicians or other healthcare practitioners who are using such equipment should follow certain guidelines for DME billing services that are released by the Hawaii Medical Service Association (HMSA).

Use Modifiers:

Although, it is essential for healthcare practitioners to use accurate HCPCS codes to define the medical necessity of their equipment. They should also include information about whether they have used the device, new, rented or on a capped basis in the form of appropriate modifier defined in HCPCS codes.

It is the most essential factor in DME billing services, that HSMA approves your medical claims. In addition to this, doctors should also mention medical codes or modifiers for respective durable medical equipment.

Additionally, they should also mention the month from when the rental of these items began. But they should also use a proper set of medical codes to define this time duration.

Conclusively, it is necessary to mention the complete time period (beginning and ending dates) for the rental period of equipment. Also, physicians should take care that their billing staff should translate the following information into standard modifiers while delivering DME billing services.

Which Information Is Defined By Modifiers?

Medical billers should use appropriate modifiers to define the following information in medical claims;

  • Rental; it is defined under the heading of RR.
  • When a patient purchases a used equipment then it is defined as UE.
  • When a patient purchases a new equipment then it is defined as NE.

Medical billers can use above-mentioned modifiers in patient bills in the following categories;

  • Capped Rental item.
  • Routinely Purchased or inexpensive (IRP) item.
  • Oxygen equipment (not contents).
  • Items requiring substantial and frequent servicing.

If a patient has not purchased an equipment but pays rent for the time then he/she should pay for the equipment after every 30 days. However, if the physician has defined a daily rental on the equipment then the patient should follow the payment guidelines defined for the daily rental.

If the patient is using DME by paying capped rents then medical billers should also mention extra information than RR only. Medical coders or billing specialists can use one of the following modifiers to define the rental period of an equipment;

  • KH – Initial claim, first-month rental.
  • KJ – 4th to 13th capped rental months.
  • KI – 2nd and 3rd capped rental months.

Guidelines Defined For Equipment Use and Maintenance:

  1. Those patients who have acquired any device on capped rental. Physicians charge them a six-month maintenance fee for justifiable, necessary parts.
  2. Labors and resources that are not covered under any supplier or manufacturer warranty were used to be covered for crapped rental equipment before 1 January 2006.

Therefore, physicians or doctors are not allowed to charge any fee for providing services of crapped rental equipment that were started from or before 1 January 2006.

  1. Payers can pay for oxygen equipment, maintenance and service fees after every six months. Once the member owns this device, he/she can pay with the starting six months of capped rent.

Rules for Replacement and Repair

Even for the replacement and repair of Durable Medical Equipment, medical billers should use standard medical codes and modifiers under HCPCS. These codes are used to define the services and maintenance claims.

HMSA has also defined new updates for these rules and regulations for DME billing services in case of replacement and repair.

Are you dealing with complications to comply with ongoing medical billing and coding updates? Medcare MSO provides completely transparent and custom-tailored medical billing services that meet the unique requirements of your speciality.


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