Florida Dermatology Billing: The Vendor Evaluation Questions That Reveal CO-50 Defense and Mohs Billing Capability

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Choosing a medical billing or RCM vendor for a Florida dermatology practice requires more than comparing collection percentages and monthly fees. Dermatology billing has specialty-specific risks, particularly when a practice performs Mohs micrographic surgery, pathology-related services, biopsies, and other procedures where documentation, medical necessity, coding, and payer policies directly affect reimbursement. One important area to examine is the vendor's ability to prevent and defend CO-50 denials . CARC 50 indicates that a service was considered non-covered because the payer did not determine it to be medically necessary. CMS guidance also shows that CO-50 can be used following medical review when a payer determines that coverage requirements have not been met. For a Florida dermatology practice, the vendor evaluation process should therefore go beyond asking, "How much do you collect?" The better question is: "How do you protect our revenue when a payer challe...
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Medicare and DME- Know more

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medicarerulefacetofaceinterviewfordmeitems.jpg

Did you know that since October 2013 physicians need to conduct a face-to-face interview with the proposed beneficiaries before ordering durable medical equipment? This is one of the rules specified by Medicare, which further clarifies the need to document the data in the patient’s records. A copy of this medical record needs to be sent to the supplier of the ordered DME.

Documentation- During such a face-to-face meeting there needs to be enough documentation in the relevant parts of the patient’s medical records justifying the beneficiary’s eligibility for the particular piece of durable medical equipment ordered on behalf of the patient. The physician also needs to be familiar with the Medicare policy requirements for the same. The particular policy clearly explains the specific conditions that qualify a patient for that particular DME. The relevant documentation of the medical record needs to be furnished with the suppliers of the DME who will need it before they can submit the claim forms to Medicare.

Role of the Physician- While a practitioner who is not a physician is eligible to conduct the face-to-face meeting; it is still the physician who should do the documentation on behalf of the beneficiary. The physician has to cosign the document signed by the non-physician practitioner (nurse practitioners, clinical nurse specialists, and physician assistants) who conducted the face-to-face. This is to ensure that the evaluation of the beneficiary was documented regarding the DME on that particular date of service. A signed order in place of a signed medical order does not hold well and is not the same as the physician cosigning the particular medical record. Hence DME billing is a crucial part.

Post-Documentation- Once the documentation is done after the exam, the physician needs to communicate the same to the supplier of the DME. The DME supplier on his or her part needs to be able to access the records of the face-to-face meeting and needs to maintain a copy of the written order along with other supporting documents and produce them on demand by CMS. What’s more, is that it is mandatory to hold these records for a minimum period of 7 years. The face-to-face interview being a precondition for payment, the DME supplier needs to maintain a copy of the records and produce it whenever required to Medicare.

To learn more about Medicare and DME- Know more, click here: https://bit.ly/3NJiZ0I  Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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