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BMS Announces DME Mock Audit Reviews

DME/HME has the highest level of insurance fraud and abuse among all areas of the heathcare industry. All DME/HME providers must be prepared for an audit notification from Medicare.

 
Aug. 18, 2010 - PRLog -- As a full service DME billing company, Billing Management Services (BMS) strives to provide timely services to its clients and the non-client providers that it serves.  BMS is announcing today the addition of timely and necessary mock audit reviews to its list of services.  2010 has seen two DME MAC jurisdictions perform internal analyses of claims submitted to them.  Perhaps the most shocking of the analyses came from Jurisdiction A.  DME MAC A performed a claims review for the Second Quarter for claims paid from April 1, 2010 thru June 30, 2010 and found that out of 1000 claims submitted by suppliers, 763 were denied, resulting in a denial rate of 76.3%.  What makes this an astounding number is the DME MAC only reviewed one HCPC code: K0823 (power wheelchairs).  78.9% of the claims were denied for incomplete documentation.  16% were determined to be medically unnecessary.  While the denials could be innocent and lack of documentation or medical necessity an inadvertent error, such denials with regularity could make a DME/HME supplier susceptible to Medicare auditors and claims reviewers.  A provider must always be prepared for audit notification.

The mock audit services that BMS will provide allows a DME/HME provider to determine if he or she is prepared for a Medicare audit, should his or her store be selected.  During the mock audit performed by BMS, a sampling of files will be reviewed by experienced DME specialists and analyzed for several areas:

1-Documentation
2-Diagnosis linkage
3-Dates of Service and Delivery Dates
4-And other key indicators

When BMS launched its new website two months ago, it included a very helpful and useful Clients Only section.  All BMS clients have access to this area where they can find links to CMS and Medicaid Certificates of Medical Necessity and other required documentation that will help keep patient records compliant with rules and regulations.  For those providers that are not BMS clients, such documentation can be provided based on the results of the mock audit.  If you have any questions about what documentation and forms are necessary to support the charges for any equipment or supplies, please contact BMS.  The DME specialists at BMS are always available for coverage questions.

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Billing Management Services is a full-service durable and home medical equipment billing company that specializes in DME billing and consultation services.

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Source:Billing Management Services
Phone:903-438-0317
Zip:75482
Location:Sulphur Springs - Texas - United States
Industry:Business, Health, Services
Tags:Durable, Medical, Equipment, Audits, Reviews, Medicare
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