URGENT UPDATE TO MEDICARE PROVIDERS!
 
Power Mobility
 
 
Billing Tilt-In-Space MWCs now Categorized as a Capped Rental
 

With the change of the E1161 (Tilt-in-Space MWC) to a capped rental effective April 1, 2014, Medicare will now reimburse for this MWC base over 13 months. The proper billing for the E1161 as a capped rental is as follows:

 

BLOCK 24 CMS-1500 Form

 
The First Month of Rental, bill the E1161 using the modifiers RR KH KX
The First Month of Rental, bill the E1161 using the modifiers RR KI KX
The First Month of Rental, bill the E1161 using the modifiers RR KJ KX
PM News In This Issue PM News
 
Billing Tilt-In-Space MWCs now Categorized as a Capped Rental
 
Notice of Service-Specific Pre-payment Review for Certain HCPCS Codes
 
 

KEY - Capped Rental Modifiers
RR – Rental
KH – First Month Rental
KI – Second or Third Month Rental
KJ – Months Four To Thirteen
KX – Requirements Specified In The Medical Policy Have Been Met

 

E1161 Allowable Calculation:

 

For the first three rental months, the rental fee schedule is calculated so as to limit the monthly rental to 10 percent of the average allowed purchase price.

 

For each of the remaining months (4-13), the monthly rental is limited to 7.5 percent of the allowed purchase price (in other words, the payment is reduced by 25% beginning in the fourth month of rental).

 

EXAMPLE:

 

E1161 Rental Allowable for Months 1 – 3 are reimbursed at the 2014 Capped Rental fee schedule amount of $258.74

 

$258.74 x 3 = $776.22

 

E1161 Rental Allowable for Months 4 - 13 are reimbursed at 75% of the 2014 Capped Rental fee schedule amount of $258.74, or $194.06

 

$194.06 x 10 = $1,940.60

 

Total reimbursement over the 13 Month Capped Rental Period for the E1161 base = $2,716.82

 

Billing Accessories with an E1161:

 

All accessories that currently fall under the Inexpensive and Routinely Purchased Payment Category will continued to be paid as a purchase with one exception - Elevating Leg Rests (ELRs).

 

When ELRs are provided on a Capped Rental base providers are required to be bill the ELRs monthly as a Capped Rental using code K0195. The same Capped Rental modifiers will apply to the K0195 code (reference E1161 billing above).

 

The allowable calculation for the K0195 – Capped Rental ELRs, is the same as the E1161 base.

 
 
 
 
Notice of Service-Specific Pre-payment Review for Certain HCPCS Codes
 

The Jurisdiction C DME MAC recently announced that they will be implementing an edit to verify that providers are complying with the Affordable Care Act - Section 6407, that requires the provider to obtain a Detailed Written Order (DWO) prior to delivery and the provider is in compliance with the written order guidance published in the CMS Program Integrity Manual Chapter 5, Section 5.2.3.

 

Claims for the HCPCS codes listed below will be subjected to this edit and will be developed for additional documentation.

 

Providers will be asked to submit documentation including, but not limited to:

 

Detailed written order;

  • Delivery documentation;
  • Any other pertinent records; and 
  • Copy of Advance Beneficiary Notice (ABN) if one was obtained
 

The HCPCS codes affected by this Pre-payment Review include:

 

E0250 (Fixed Height Hospital Bed)
E0255 (Variable Height Hospital Bed)
E0607 (Home Blood Glucose Monitor)
E0730 (Transcutaneous Electrical Nerve Stimulation [TENS] Device)
E0748 (Osteogenesis Stimulator, Electrical, Non-Invasive, Spinal Applications
E2402 (Negative Pressure Wound Therapy Electrical Pump, Stationary or Portable)
E2510 (Speech Generating Device, Synthesized Speech, Permitting Multiple Methods of Message Formulation and Multiple Methods of Device Access)
K0001 (Standard Manual Wheelchair)
K0002 (Standard Hemi [Low Seat] Manual Wheelchair)
K0003 (Lightweight Manual Wheelchair)
K0004 (High Strength Lightweight Manual Wheelchair

 

Do not ignore these letters requesting the additional documentation. Failure to provide the proper information will result in a claim denial.



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The MOBILITY Consultants is in the business of providing a comprehensive resource for mobility reimbursement and regulatory compliance issues. For more information on The MOBILITY Consultants and a menu of services we offer, visit our website atwww.themobilityconsultants.net.





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