Medicare B Billing

[rickyroxy]

How many of you find it confusing when you receive script for pulmicort or test strips faxed to you without diagnosis code or called in. How do you make sure that you have a hard copy script with diagnosis code mailed to you? How about patient from another state trying to refill test strips and we transfer through computer, we do not have hard copy or diagnosis codes. What's the best practice to avoid audits?

 

[ResCon]

You don't need a diagnosis code on a script for Medicare Part B DME, but you do need the medical records, especially for test strips to document medical necessity. E-Prescribing is allowable under Part B, and electronic signatures are acceptable on the prescriptions (referred to as "Detailed Written Orders") as are facsimiles (faxes), as long as the doctor personally signs and dates the order. You can fill out the order yourself and fax it to the doctor, hopefully they will fax back with their dated signature (and if illegible their printed name).

The biggest pain obviously is the medical records, since Medicare will initiate a refund request if they aren't furnished within something like 30 days of the request date (note: not the request receipt date).

ZPICs (Zone Program Integrity Contractors) are ferocious in their auditing.

 

[ResCon]

PS - Remember you can dispense to the patient with just a verbal order, but you cannot bill until all the program integrity requirements have been met