e: [email protected] mobility o: 844-794-8459 c: … bad mobility.pdf• hcpcs code for the item...
TRANSCRIPT
9/23/2017
1
Instructor
Dan Fedor (Mobility)
O: 844-794-8459
C: 570-499-8459
Mobility
FUNding
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Welcome to VGM's Breaking BAD 2017 Reimbursement Seminar!
In this 5 hour (0.5 CEU) course Ronda Buhrmester and Dan Fedor will conduct a reimbursement analysis of the most common misconceptions about
documentation and billing (codes and modifiers) that have become protocol (habit) due to lack of clear guidance from Medicare. This lack of clear guidance
has resulted in internal protocols that are not always correct. Let's not just continue doing something because "that is how it's always been done".
Ronda and Dan will ensure you have the most updated accurate information which will enable you to do what is required in the most efficient manner.
Mobility
• Review the NEW prior authorization process for codes K0856 and K0861
(Group 3 complex rehab) effective July 17,2017 nationwide
• ADMC for other complex rehab bases
• Determine appropriate modifiers via the Modifier Match Game
(NURRKHBPRBKUKXRTLTOMG99); YOU will WIN!
• Identify clinician education best practices
• Identify key components in documentation requirements per the policies
(reading between the lines/gray areas)
• Repairs
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PAR / Non Par and Assigned Non Assigned RECAP for Mobility
Participating VS Non-Participating
• An assignment agreement is between a supplier and a Medicare beneficiary
• The option of accepting assignment belongs solely to the supplier
• Suppliers have a choice to become a participating or non-participating Medicare supplier
• Suppliers can change their participation status annually. Participation status is part of the enrollment process through the National Supplier Clearinghouse (NSC)
• Open enrollment occurs every November 15- December 31
• Must be post marked by Dec. 31 to change status for Jan. 1
• Enrollment status follows Tax ID, i.e. hospital based DMEs may be under same tax ID as hospital
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Participating
• Participation means the supplier always agrees to accept assignment for all services furnished to Medicare beneficiaries during a 12-month period, beginning January 1 of each year
• By agreeing, the supplier always accepts the Medicare allowed amount as payment in full and doesn't collect more than the deductible and coinsurance from the beneficiary
• By accepting assignment, the payment is sent to the supplier
• If want to change from non-participating to participating, complete form CMS-460
• Suppliers awarded a CB contract must accept assignment
Non-Participating
• Suppliers who choose not to sign the participation contract are referred to as non-participating suppliers
• The non-participating supplier can choose on a claim by claim basis whether or not to accept assignment, except where CMS regulations require mandatory assignment
• Non participating suppliers are not required to file a claim to secondary insurance
• Suppliers are able to collect the payment upfront from the beneficiary. The charge is more than the Medicare allowed amount
• Non-assigned claims, the Medicare payment (80% of allowed amount) is sent to the beneficiary (if approved)
• Non-participating suppliers are required to accept assignment when beneficiary has both Medicare and Medicaid
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• Beneficiary authorization is required each month prior to billing non-assigned claim for rental items
• If switching from assigned to non-assigned on a claim (rental), need to notify beneficiary prior to and get authorization
• Either give beneficiary option of choosing item that supplier does accept assignment
• Or, beneficiary can find a supplier that accepts assignment for that item
• Watch orders, if current order specifies a particular brand or feature of an item, a new order may need to be obtained before supplier will be able to supply the patient a different item
• This could mean a new physician visit to get new order
Non-assigned Considerations
Assignment of Benefits
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ABN – Advance Beneficiary Notice RECAP for Mobility
• An Advance Beneficiary Notice (ABN) is a written notice that suppliers may give to a Medicare beneficiary before providing items and/or services that Medicare otherwise might NOT pay for
– Lack of medical necessity
- Same / similar denial
- Upgrade
• The ABN allows the beneficiary to make an informed consumer decision as to whether or not to receive the items or services for which he or she may have to pay out of pocket or through other insurance
• HCPCS code for the item that is provided (but that does not meet coverage criteria) with a GA modifier on one claim line and the HCPCS code for the item that meets coverage criteria with a GK modifier on the next claim line. (Note: The codes must be billed in this specific order on the claim.)
In box D you must enter the items that are expected to deny and in box E the reason Medicare may not pay
A. Notifier:
B. Patient Name: C. Identification Number:
Advance Beneficiary Notice of Noncoverage (ABN)
NOTE: If Medicare doesn’t pay for D. below, you may have to pay.
Medicare does not pay for everything, even some care that you or your health care provider have
good reason to think you need. We expect Medicare may not pay for the D. below.
D. E. Reason Medicare May Not Pay: F. Estimated Cost
Power wheelchair and Accessories (details)
The manual chair and scooter were not ruled out due to weakness as stated with a manual muscle test of 5/5 BUE
$4500.00
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Upgrades – Patient Wants
• Additional financial liability to patient when they SELECT to upgrade
• Want versus need
• Charge patient difference between your usual and customary charge and allowable for covered item
• Must be within the same range of services that are appropriate for medical condition
• Can upgrade from standard power chair group 2 to a group 3
WANTS: K0849RRKHGA (Patient requested upgrade and valid ABN on file)
NEEDS: K0823RRKHGKKX (Reasonable & necessary item)
Can only rent even as UPGRADE since the item the patient qualifies for is RENTAL ONLY
Upgrades – No Charge
• The supplier SELECTS to provide patient with upgrade and no additional charge for upgrade
• Does not need to sign an ABN—because not charging more than normal deductible and co-insurance
Example:
You choose to only keep K0004 manual chairs in stock for low inventory
Doctor orders K0001 Standard and patient meets criteria for standard manual
K0001 RRKHKXGL (extra narrative list item actually provided)
Deliver a medically unnecessary upgrade to patient at no charge, and no ABN was signed
Add note in narrative on claim what patient actually received using HCPCS, make/model and reason for upgrade
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If the beneficiary wants the item but does NOT want you to bill Medicare the beneficiary must check Option 2 (required for retail transactions)
You may NOT choose a box for the beneficiary
G. OPTIONS: Check only one box. We cannot choose a box for you.
☐ OPTION 1. I want the D. listed above. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN. If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles.
☐ OPTION 2. I want the D. listed above, but do not bill Medicare. You may ask to be paid now as I am responsible for payment. I cannot appeal if Medicare is not billed.
☐ OPTION 3. I don’t want the D. listed above. I understand with this choice I am not responsible for payment, and I cannot appeal to see if Medicare would pay.
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Dissecting the Fee Schedule RECAP for Mobility
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Group 2 Power Chair K0823
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Calculating Allowed Amount (Capped Rental – RENTAL ONLY Allowable AFTER 13 Months)
Power Wheelchair Bases (K0812-K0831) – RR Allowable divided by .15 = Purchase Allowable
15% of the Purchase Allowable each Month for Months 1-3 (45% total)6% of the Purchase Allowable each Month for Months 4-13 (60% total)
Total Allowed Amount AFTER 13 Months – 105% of the Purchase Allowable
K0823 (group 2 standard captain seat power base) allowable in the fee schedule for TX (rural) = $294.71
Purchase Allowable = $1964.73 (RR divided by .15)Months 1-3 = $294.71 each month = $884.13 (45% of purchase allowable)Months 4-13 = $117.88 each month = $1178.84 (60% of purchase allowable)
Total Allowed Amount AFTER 13 Months = $2062.97 (RR divided by .15 times 1.05)
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Group 3 Power Chair K0861
Calculating Allowed Amount (Capped Rental with Purchase Option)
Power Wheelchair Bases (K0835-K0864) – RR Allowable divided by .15 = Purchase Allowable
15% of the Purchase Allowable each Month for Months 1-3 (45% total)6% of the Purchase Allowable each Month for Months 4-13 (60% total)
Total Allowed Amount AFTER 13 Months – 105% of the Purchase Allowable
K0861 (group 3 multiple power base) allowable in the fee schedule for TX (rural) = $817.69
Purchase Allowable = $5451.27 (RR divided by .15)
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Payment Categories
Rule of Thumb
• If the base that the capped renal accessory is being used with has the purchase option then the capped rental accessory has the first month purchase option.
• If the base that the capped rental accessory is being used with doesn't have the first month purchase option then the capped rental accessory doesn't have the first month purchase option and can only be rented except as a repair (RB) where all codes are paid on a lump sum regardless of the base code.
Billing Scenario Examples - Capped Rental Accessory
Capped rental accessory (E1002) provided on a group 3 complex rehab power base regardless of where the beneficiary resides
o E1002 NUKHBPKUKXo Allowable in TX - $388.89 (with KU)o Purchase Allowed Amount - $3888.90 (RR x 10)
Capped rental accessory (E1002) provided on a group 2 complex rehab power base regardless of where the beneficiary resides
o E1002 NUKHBPKXo Allowable in TX - $346.16 o Purchase Allowed Amount - $3461.60 (RR x 10)
Additional Allowed Amount with KU (group 3 accessories) = $427.30
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Calculating Allowed Amount Capped Rental Accessory
E1028 (swing away mounting hardware) fee schedule for TX
Group 2 Complex Power Base (K0835-K0843)
RR (rural) - $14.14 listed on fee schedule Purchase Allowable - $141.40 (rental fee times 10)MUST use KY IF Bene Resides in CB AREA
Group 3 Complex Power Base (K0848-K0864 with KU modifier)
RR - $19.81 listed on fee schedule (only non rural fee listed)Purchase Allowable - $198.10 (rental fee times 10)
Calculating Allowed Amount (IRP)
Scooters (K0800-K0802) – NU / UE / RR
K0800 (group 1 standard scooter) fee schedule for TX
NU (rural) - $882.86 (RR times 10)RR (rural) - $88.29 (NU divided by 10)UE (rural) - $662.15 (NU times .75)
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Calculating Repair Payments
CR 9579 – Effective Oct 1, 2016 / Implementation Oct 3, 2016
• The regulations at 414.210(e) also provide that payment for repair parts is made on a lump sum purchase basis. Therefore, effective October 1, 2016, all repair part claims billed with the RB modifier, whether within or outside a competitive bidding area, whether described by a HCPCS code that is a competitive bidding item or not, and whether described by a code for miscellaneous (not otherwise classified or specified) items or not, shall be paid on a lump sum purchase basis.
Modifier GAME
KH BP
RB
KU
RR
KY
KX 99
GA
Match
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Modifier Match GAME
NU–New Item Purchase
UE–Used Item Purchase (25% less than new)
RR–Rental (capped rental only lists RR)
KH–1stMonth of Capped Rental
KI–2ndand 3rdMonth of Capped Rental
KJ –4th–13thMonth of Capped Rental
BP–Beneficiary Elected the Purchase Option
KX–Coverage Criteria has been met per Policy
Modifier Match GAME
KY – Item used on Complex Wheelchair Base (processing to allow a CB item on a non CB base non contract provider)
KU – Item used on group 3 power wheelchair base to override the adjusted fee schedule for competitive bidding (pay at unadjusted fee schedule….MORE MONEY)
GA – ABN executed for denial or upgradeRB – Repair / Replacement of Basic Equipment Package RT – RightLT – Left99 – More than 4 Modifiers Requires (see extra narrative)
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Modifier Match GAME - KY and KU Rule of Thumb
KY Modifier
• Not use with replacement parts with RB mod
• Used when bene resides in CB area, providing CB accessories on non CB bases (E1161, K0005 and K0835-K0843)
• Not use on group 3 accessories as KU overrides the KY
KU Modifier
• Used on affected accessories when on a group 3 power base
• Valid from DOS Jan 1, 2016 – June 30, 2017
• Receive HIGHER ALLOWED AMOUNT via the Unadjusted Fee Schedule rather than the CB Adjusted Fee Schedule
Ensuring Accurate Reimbursement for Group 3 Accessories
• Affected Group 3 Accessories with DOS Jan 1, 2016 – Present
• Written Reopening Request to Reprocess the Affected Codes Listed by ADDING the KU Modifier (YOU MUST STATE PLEASE APPEND /ADD THE KU MODIFIER TO THE LISTED CODES)
• Current Claims for Affected Accessories used on Group 3 Power Bases should INCLUDE THE KU Modifier
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Recovering Underpayments for Group 3 Accessories
You may use a reopening form to request a written reopening or you may submit as a spreadsheet with all the required information if you have multiple requests.
If submitting a request in the form of a spreadsheet, please include the information below:
The beneficiary's name
The Medicare Health Insurance Claim Number (HICN) of the beneficiary
The specific services(s) and/or item(s) for which the reopening is being requested and the specific date(s) of service,
The wheelchair base with which the accessory is being used
The supplier’s PTAN
The printed name and signature of the person filing the request
Recovering Underpayments for Group 3 Accessories
Please submit a written reopening to the appropriate DME MAC.
DME MAC A - https://med.noridianmedicare.com/web/jadme/claims-appeals/appeals/reopening
DME MAC B -http://www.cgsmedicare.com/partb/forms/gateways/reopenings.html
DME MAC C -https://www.cgsmedicare.com/jc/claims/reopenings.html
DME MAC D - https://med.noridianmedicare.com/web/jddme/claims-appeals/appeals/reopening
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Every Penny Counts: Reopen CURES Act Adjusted Claims for an Additional 5%
• The CURES Act adjustments are complete, and providers can submit a written reopening for affected accessories used on non-bid manual wheelchair bases (complex rehab) to receive an additional 5 percent. While 5 percent may not seem like much, it can add up, and in this reimbursement environment every penny counts.
• When the affected accessories are used on the following bases, regardless of where the beneficiary resides, with a date of service between July 1, 2016, and Dec. 31, 2016, AND the claims have already completed the CURES Act mass adjustment (verify with a remittance notice), then proceed with the written reopening for the additional 5 percent.
Every Penny Counts: Reopen CURES Act Adjusted Claims for an Additional 5%
• HCPCS bases – K0005, K0009, K0898, E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, and E1239
• To recoup the money owed to you, please enter the website below for additional information from each DME MAC, and follow their specific instructions to submit the written reopening.
• The instructions include a list of the affected accessories and forms you will need.
• DME MAC B and C -https://cgsmedicare.com/jc/pubs/news/2017/0817/cope4270.html
• DME MAC A and D - https://med.noridianmedicare.com/web/jddme/claims-appeals/cr9968-cures-act-fee-schedule-adjustments
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Modifier Match GAME - RT LT Modifier
The right (RT) and left (LT) modifiers must be used when appropriate.
• If bilateral items are provided and the unit of service is "pair", the LT and RT modifiers do not need to be reported.
• If bilateral items (left and right) are provided as a purchase and the unit of service of the code is "each" bill both items on the same claim line using the LTRT modifiers and 2 units of service.
• If bilateral capped rental on one line NO RT / LT required.
• Capped Rental Item EACH – RT LT MUST be in 2nd and 3rd Positions
Modifier Match GAME - Capped Rental Parts
When to USE the RB
When the part being replaced is included in the basic equipment package (BEP) for the item being repaired
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Billing Scenario Examples - Capped Rental Parts
Please note when there are more than 4 modifiers required the 99 must be used in the 4th space and additional modifiers added in the extra narrative field.
Note: KH 1st month, KI 2nd and 3rd, KJ 4th – 13th
Capped rental replacement part (E2374) on a group 1 and group 2 power chair
o Joystick E2374 NUKHRBKX
Capped rental replacement part (E2374) on a Group 3 complex powerbase (K0848-K0864)
Joystick E2374 NUKHRB99 extra NUKHRBKUKX
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Billing Scenario Examples - Capped Rental Parts
Capped rental replacement part (E2370) on any group 1 and group 2 power chair (2 units)
Motor / Gear E2370 NUKHRBKX
Capped rental replacement part (E2370) on a Group 3 complex power base (K0848-K0864) (2 units)
Motor / Gear E2370 NUKHRBKUKX
Modifier GAMEMatch
K0823 (1) _________
EXTRA NARRATIVE FIELD_______________________________
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Modifier GAMEMatch
K0861 (1) _________
EXTRA NARRATIVE FIELD_______________________________
Modifier GAMEMatch
E1012 (1) __________
EXTRA NARRATIVE FIELD_______________________________
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Modifier GAMEMatch
E2370 (2) _________
EXTRA NARRATIVE FIELD_______________________________
Modifier GAMEMatch
E2361 (2) __________
EXTRA NARRATIVE FIELD_______________________________
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Modifier GAMEMatch
K0019 (2) __________
EXTRA NARRATIVE FIELD_______________________________
Prior Authorization for PMD Codes K0856 and K0861 began NATIONWIDE July 17, 2017!
• Prior authorization (PA) for power wheelchair codes K0856 (group 3 single power option) and K0861 (group 3 multiple power option) began in March 2017 for the following states:
• New York,• Illinois, • Missouri and • West Virginia
Nationwide with DOS July 17,2017!
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Differences between ADMC (Advance Determination of Medicare Coverage) and PA (Prior Authorization)
ADMC is optional / PA is required - Once PA is implemented (either in March as noted above or nationwide in July 2017) you MUST use the PA process for K0856 and K0861 or the claim if submitted will be DENIED
ADMC requests required a home assessment / PA does not require a home assessment with the request (a home assessment may be performed AFTER the PA determination (before or on the delivery date)
ADMC only allowed 2 submissions within a 6 month period / PA process offers unlimited submissions
ADMC has a 30 days response time / PA has a 10 business days response time for initial submissions and subsequent requests within 20 days
6 Months to Deliver for BOTH PA (K0856 and K0861) and ADMC for ALL
PA - Only accessories that the base is contingent on will be reviewed!!!!
The following wheelchairs are eligible for ADMC
• Manual wheelchairs
• E1161, K0005, and K0009 • E1231–E1234
• Power wheelchairs
• Group 2 (K0835–K0843) (If PAR state use PAR)• Group 3 (K0856–K0864) (NOTE PAR effective date)• Group 3 (K0848–K0855) provided with an alternative drive control
interface (E2321–E2322, E2325, E2327–E2330) • Group 5 (K0890, K0891)
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Initial Repair Considerations
Beneficiary is seeking Medicare to pay for the repair
Initial Repair Considerations
Who provided the Item in need of repair
Who was the payer source for the Item in need of repair (Medicare, Medicaid, Private)If Medicare was not the payer source then medical necessity must be established for the item (per policy)
Verify proof of payment when Medicare was payer sourceIf Medicare was the payer source and the original item hasn’t been paid for (denied/in appeal) then the repair will NOT be covered
Is the item being rented or patient owned equipmentIf the item is being rented then the supplier is responsible for the repair Medicare pays for repairs for patient owned equipment
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Initial Repair Considerations
Is the part / labor covered under a manufacturer or supplier warrantyIf the item is covered under warranty then Medicare will not pay Medicare pays for repairs for parts and labor not under warranty
Does the patient have Medicare and Medicaid If the patient has Medicare and Medicaid then you must
accept assignment
Does the bene reside in a CBAIf so, then you need to determine if the item is considered a repair or a replacement
Repair Scenarios
You provided the original item
Original provider is out of business or won’t repair the product
Beneficiary resides in a competitive bid area
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Repair Scenario – You Provided the Original Item
Medicare Paid Patient Owned Out of Warranty
In this scenario Medicare will reimburse for parts and labor.
Documentation Required
o The supplier’s record includes the nature of the repair required and work performed to restore the item to its functionality to meet the Medicare beneficiary’s medical need. (work order with specific parts in need of repair, labor and allowable per item).
o Documentation from the physician or treating practitioner that indicates the wheelchair being repaired continues to be medically necessary is required.
o For this purpose, documentation is considered timely when it is on record in the preceding 12 months.
Repair Scenario – You Provided the Original Item
Medicare Denied (claim is in appeal) OR Recouped in Audit Patient Owned Out of Warranty
In this scenario Medicare will NOT reimburse for parts and labor.
Documentation Required
o N/A
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Repair Scenario – You Provided the Original Item
Paid by Private Insurance or Medicaid Patient Owned Out of Warranty
In this scenario Medicare will reimburse for parts and labor.
Documentation Required
o The supplier’s record includes the nature of the repair required and work performed to restore the item to its functionality to meet the Medicare beneficiary’s medical need. (work order with specific parts in need of repair, labor and allowable per item).
o Review the Original documentation to determine that the wheelchair being repaired meets MEDICARE’s coverage criteria (ruling out all least costly alternatives with objective measurements).
o If original documentation is over 12 months then in addition to verifying medical necessity you need documentation to verify continued medical necessity within the preceding 12 months of the repair.
Repair Scenario – You Provided the Original Item
Medicare Paid Under Capped Rental Under Warranty
In this scenario Medicare will NOT reimburse for parts and labor.
Documentation Required
o N/A
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Repair Scenario – You Did NOT Provided the Original Item
Medicare Paid Patient Owned Out of Warranty Beneficiary Resides in CB Area You are a NON Contract Provider
In this scenario Medicare will reimburse for a repair. Parts that are part of the repair in making the chair operable can be provided by any Medicare enrolled provider. Replacement of an entire item may only be provided by a contract provider.
Documentation Required
o The supplier’s record includes the nature of the repair required and work performed to restore the item to its functionality to meet the Medicare beneficiary’s medical need. (work order with specific parts in need of repair, labor and allowable per item).
o Documentation from the physician or treating practitioner that indicates the wheelchair being repaired continues to be medically necessary is required. For this purpose, documentation is considered timely when it is on record in the preceding 12 months.
Repair Scenario – You Did NOT Provided the Original Item
Paid by Private Insurance, Medicaid or Private Pay Patient Owned Out of Warranty
In this scenario Medicare will reimburse for parts and labor as part of a repair. Parts that are bid items will pay at the single payment amount.
Documentation Requiredo The supplier’s record includes the nature of the repair required and work performed to restore the
item to its functionality to meet the Medicare beneficiary’s medical need. (work order with specific parts in need of repair, labor and allowable per item).
o Obtain documentation to determine that the wheelchair being repaired meets MEDICARE’s coverage criteria (ruling out all least costly alternatives with objective measurements).
o Documentation from the physician or treating practitioner that indicates the wheelchair being repaired continues to be medically necessary is required. For this purpose, documentation is considered timely when it is on record in the preceding 12 months.
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Repair Documentation Requirement
o The supplier’s record includes the nature of the repair required and work performed to restore the item to its functionality to meet the Medicare beneficiary’s medical need. (work order with specific parts in need of repair, labor and allowable per item).
• Technician work order
o Documentation from the physician or treating practitioner that indicates the wheelchair being repaired continues to be medically necessary is required. For this purpose, documentation is considered timely when it is on record in the preceding 12 months.
Any of the following may serve as documentation justifying continued medical need:• A recent change in prescription• Timely documentation in the beneficiary's medical record showing usage of the
item.• Timely documentation is defined as a record in the preceding 12 months unless
otherwise specified elsewhere in the policy.
Repair / Replacement (Base) Documentation Requirement
o The supplier’s record includes the nature of the repair required and work performed to restore the item to its functionality to meet the Medicare beneficiary’s medical need.
• Technician work order • Including each part in need of repair• Labor • Total cost (allowable) to make the chair operable
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Beneficiary Resides in a CB Area
o Beneficiaries are required to obtain replacement of all competitively bid items that are not part of a repair from a contract supplier when these items are furnished to a beneficiary in a CBA.
o A replacement of a beneficiary- owned seat cushion used with a standard power wheelchair must be obtained from a contract supplier in all cases.
o If a damaged valve stem on a beneficiary-owned seat cushion is being replaced in order to repair the seat cushion, the replacement valve stem can be considered a repair part and provided by any Medicare enrolled provider
Repair Modifier
o The RB modifier must be used with the HCPCS code for all replacement parts furnished in conjunction with the repair of beneficiary-owned base equipment.
Temporary Replacement Equipment (TRE)
AKA Loaner
• If YOU BILLED IT (K0462), THEY (Medicare) Will Pay…….
• If you provide IT (temporary replacement equipment), while patient owned DME is being repaired, THEY (Medicare) WILL Pay.
• “It's NOT a LOANer!”
• Loaner definition: One that is lent (usually free of charge) especially as a replacement for something being repaired.
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If you provide a service / product you should be reimbursed for that service or product. When you repair patient owned DME that is not covered by a manufacturer or supplier warranty and you provide equipment for the patient to use while their equipment is being repaired, you are entitled to reimbursement for that temporary replacement equipment (TRE).
The code is K0462 (NO modifiers required) and you are entitled to one unit (1), which is one month of reimbursement (rental span) for a repair which takes longer than one day (24 hours).
Meaning if the patient owned DME is inoperable (safely) and the repair will take longer than one day you can submit one unit of K0462 along with the part(s) and labor.
Temporary Replacement Equipment (TRE) – AKA Loaner
Documentation requirements for billing code K0462
• A narrative description of the equipment being used as a temporary replacement, including the manufacturer, brand name, model name or number of the temporary replacement item
• A statement of why the replacement is needed
• Claims must include the HCPCS code and or manufacturer name, brand name, and model name or number of the beneficiary-owned piece of equipment and the date of purchase of the equipment
• Must abbreviate to fit it in to extra narrative
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Breaking BAD
Mobility
Thank You for Attending!