CMS 2018 Documentation Guidelines for DME

Event Information
Product Format
Prerecorded Event
Lynn M. Anderanin, CPC, CPMA, CPPM, CPC-I, COSC
60 minutes
Product Description

Compliance with CMS Documentation Guidelines for DME to Avoid Overpayments and Recoupments in Medicare

Durable medical equipment (DME) billing continues to be scrutinized by Medicare and other commercial carriers. The Centers for Medicare and Medicaid Services (CMS) have extensive and detailed documentation guidelines for DME in general, as well as other guidelines for documentation that can be found in Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs). Without knowing and understanding what the requirements are, you are putting your office at risk of failing an audit, and having to refund insurance carriers or CMS.  These will be losses in revenue because your office has paid for these items, and you cannot hold the patient responsible. DME items are not professional services, so you are purchasing DME in hopes that you will receive a profit in return.  If you are audited and do not have the proper documentation, you will have to refund, and possibly be penalized for not following the published requirements.

Join this session with coding expert Lynn M. Anderanin, CPC, CPMA, CPC-I, CPPM, COSC, where you will learn about the complicated documentation requirements for DME from a general rules perspective as well as what is needed for specific kinds of DME. Lynn will direct you in using modifiers needed for reimbursement. You will feel confident that you have documented what is required to receive payment on a part of your office that can either be profitable or a big loss.

Session Highlights

This session will discuss:

  • How to read and summarize LCD and NCD verbiage for DME documentation requirements
  • What makes a complete order for DME
  • When a certificate of medical necessity is required for CMS
  • The latest policies from major insurance carriers on pre-authorization requirements
  • What proof of delivery rules you should be following
  • Advanced beneficiary notices for Medicare and commercial insurance carriers
  • The use of modifiers relevant to confirming you have the proper documentation

Session Highlights

  • Policy article changes November 2017
  • CMS program integrity manual chapter 5
  • DME documentation requirements
    • Physician order
    • Signed medical necessity statement
    • Chart documentation requirements
    • Proof of delivery
    • ABN
    • Modifier information

Who Should Attend

  • Podiatrists
  • Orthopedic surgeons
  • Physical and occupational therapists
  • Orthotists
  • Administrators and office managers
  • Orthotic technicians
  • Coders
  • Billers
  • Transcriptions
  • Scribes

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About Our Speaker

Lynn Anderanin - Orthopedic Guidelines Expert for ICD 10

Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, is the  Sr. Director of Coding Education for Healthcare Information Services, a physicians revenue cycle management company. She has over 35 years experience in all areas of the physician practice, and specializes in Orthopaedics.  Lynn is currently a  workshop and audio presenter. She is a  former member of the American Academy of Professional Coders (AAPC) National Advisory Board, and has served...   More Info
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