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Reports on the need to improve billing procedures by home medical equipment (HME) providers. Impact of reimbursement cut and policy change; Focus on accounts receivable (A/R); Aspect of work denials; Need to educate billing department; Benefits of monthly audit.

The article presents information on plans made by the department of Centers for Medicare and Medicaid Services (CMS) in the U.S. CMS has had the ability to recoup much of providers' hard-earned reimbursement by holding them responsible for what is written in physician's progress notes. The final ruling will only be binding in the Eastern District of California. CMS will most likely file an appeal since the agency feels it needs to see physician notes to determine medical necessity. To be sure, the CMN needs improvement. For example, it asks no questions regarding clinical evaluations by a physical or occupational therapist, or on physician progress notes. Although one coverage criterion states that the patient must be capable of safely operating power wheelchair controls, the CMN doesn't address the issue.

Diabetic shoes have strict criteria and guidelines that must be met for reimbursement. First, the patient must have a diagnosis of diabetes mellitus. The ICD-9 codes for coverage range between 250.00 and 250.93, and must be transmitted as a five-digit code or the claim will receive a CO-16 denial. In other words, the claim needs additional information for processing. The patient must have these following conditions documented, which includes poor circulation in either foot, loot deformity of either foot, peripheral neuropathy with evidence of callus formation of either foot, history of preeulccrative calluses of either foot, history of previous foot ulceration of either foot, previous amputation of the other foot or part of either foot.

For the past several years, providers have searched endlessly for a solution to qualifying their oxygen patients. No solution seemed possible until 2004, when the Centers for Medicare and Medicaid Services (CMS) approved the use of a home testing system for oxygen. The system, called Power-Ox, allows the DME provider to deliver an over-night pulse oximerry device to the patient's home and instruct the patient on its use. The following day, the provider returns to retrieve the device, downloads the results into a Palm Pilot-based system, and has the patient sign an Assignment of Benefit form located on the Palm device.

Focuses on the importance of correct documentation and follow-up for obstructive sleep apnea (OSA) claims. Change in coverage policies for continuous positive airway pressure devices (CPAPs) and supplies for the treatment of OSA, by the DMERC in 2002; Criteria for patients who are diagnosed with OSA to be covered for CPAPs-HCPCS code E0601; Need for documentation of all the symptoms in the patients' medical files; Importance of patient compliance and proper equipment use by OSA patients.