Medical Billing Forum

Payments => Insurance Payments => Topic started by: pvtbiller on March 28, 2012, 09:31:23 AM

Title: DME - Medicare Payouts
Post by: pvtbiller on March 28, 2012, 09:31:23 AM
Good Morning Everyone,

I hope that this post finds you all well;  I am running into an issue with our billing as a dme provider.  Our product is new to the market and has not yet has HCPCS codes assisgned to them.  The PDAC assigned codes do not fit the description accurately enough for it to work for reimbursement, not is the payout of the PDAC assigned code enough to cover the cost of the equipment.  We have had not too much of an issue getting reimbursement from juristiction D (noridian) but with all the other juristictions, it had lead to denials with extensive appeals that need to be written.  Has anyone has any experience in dealing with misc code and getting reimbursed?  I am billing L8499 for the initial date of service and the E1399 for the monthly supplies.  I am providing a very descriptive narrative, dropping all claims to paper, and providing clinical documenation supporting documenetaion.  What else can I do to get reimbursed?  We are over 90 days aging.  Someone please help.  Thank you.
Title: Re: DME - Medicare Payouts
Post by: Michele on March 30, 2012, 07:11:59 AM
Sorry but unfortunately you are swimming upstream.  New products or procedures run into this until an accurate code gets assigned that has an appropriate reimbursement rate.  I don't know of anything that you can do to help at this point in the game.  What you are doing is really all you can do without more accurate codes.  If you use an unlisted code you will have the same issues.
Title: Re: DME - Medicare Payouts
Post by: pvtbiller on March 30, 2012, 12:46:40 PM
again, thank you michelle for all your valueable advice