| One of the most confusing things to medical billing | | | | beginning with the letter K. When month number 12 hits, |
| personnel is rental modifiers. Most billers don't even | | | | the item is then transferred to a different status called |
| know what a modifier is unless they have at least had | | | | maintenance. While this is happening, the modifier that |
| some experience with rental billing. Hopefully, after | | | | is stored with the item is changed from a K modifier to |
| reading this installment, you'll have a decent idea of | | | | something else, again, depending on the item. When the |
| what modifiers are, how they work and what you | | | | insurance company sees this modifier come over on |
| have to be aware of when doing your medical billing | | | | month 13, they know the item is on maintenance and |
| duties. | | | | now pay a different allowable for it. Usually, when this |
| Rental items are a strange breed in the world of | | | | happens, the item also stops billing monthly. Depending |
| medical billing. Unlike a purchase item that is sold and | | | | on what it is, it may bill every six months or even |
| then that's the end of it, a rental item is kind of like the | | | | every year. |
| gift that keeps on giving. It is a medical billing agencies | | | | The thing that most medical billing personnel don't |
| main source of income, especially if they do a lot of | | | | understand is how this process happens. How does |
| oxygen billing which requires patients to have an | | | | the software know when to change the modifier from |
| oxygen concentrator for many months if not years. | | | | a K to a maintenance modifier? It does this by looking |
| Because of this, insurance carriers need to know, | | | | at the number of rebill pages that are in the system. |
| every step along the way, just how long a piece of | | | | Each time the system bills a rental item, because it is |
| equipment has been rented. Why? Well, this has to do | | | | not a one shot deal, it creates another billing page, |
| with certain regulations. See, once an item has been | | | | called a rebill page. So if the system has billed 11 |
| rented so many months, usually 12, it then goes on | | | | months and that's the key, it knows when it is billing |
| what is called maintenance billing. Maintenance billing is | | | | month 12 and at that time it changes the modifier |
| usually cheaper than regular billing because by the time | | | | AFTER it sends the month 12 bill. That is the key, to do |
| the 12 months have passed, the supplier of the | | | | it after and NOT before. Otherwise, the item goes on |
| equipment has already gotten their due profit from the | | | | maintenance too soon. |
| item and because of this, the insurance company | | | | It's a tricky process but it all happens behind the |
| begins to pay less starting with month 13. What does | | | | scenes. So if your DME software is functioning |
| all this have to do with modifiers? | | | | properly, you shouldn't run into any problems with your |
| From months one through 12, the modifier for the | | | | rental modifiers. |
| particular rental item will be one set of letters, usually | | | | |