Article Detail - JD DME

Suppliers engaged in Medicare billing face a significant challenge in the form of denials arising from billing claims sent to incorrect jurisdictions, beneficiaries categorized as inpatient, beneficiaries enrolled in a Medicare Advantage plan or who have secondary Medicare coverage, or from submitting claims with missing, incomplete, invalid patient identifiers. These occurrences lead to disruptions in claim processing and subsequent delays in reimbursement.

To effectively reduce these denials and ensure precise billing procedures, Noridian offers a comprehensive toolkit and resources to address these critical aspects.

Noridian's solution is the Noridian Medicare Portal (NMP), an empowering self-service platform that readily addresses a spectrum of eligibility inquiries. For suppliers who lack NMP access, the Interactive Voice Response System (IVR) is on hand to furnish the same vital information.

During the intake process, it is paramount for suppliers to gather extensive beneficiary information. Maintaining a copy of each beneficiary’s Medicare card in their records is recommended whenever feasible. This card presents pivotal details, encompassing the beneficiary's name, Medicare ID, and effective dates of enrollment into Medicare's hospital and/or medical plans. It's important to note that beneficiaries might not be enrolled in both Medicare Part A and B, with Part B being an elective option. The lower section of the beneficiary’s Medicare card identifies enrollment plans and effective dates, this information is crucial. For DMEPOS services to qualify for coverage, the beneficiary must be enrolled in Medicare Part B, which is indicated on their card.

To ensure the accurate processing of Medicare claims, it's imperative that the beneficiary's complete name (matching the legal name on file with the Social Security Administration), Medicare ID, and permanent address (as recorded with the Social Security Administration) are correctly entered onto all claim forms.

For comprehensive guidance on resolving or preempting denials, the NMP Inquiry Guide serves as a valuable resource, offering insights into various critical categories:

• Eligibility
  • Part A and B effective and termination dates
  • Beneficiary permanent address
    • If address changes are necessary, claims should be directed to the jurisdiction where the beneficiary's permanent residence is registered with the Social Security Administration
    • Any necessary changes require the beneficiary to contact the Social Security Administration (800-772-1213)
• HMO/MA
  • Insurer Name
  • Plan Code Number
  • Effective and Termination Date
  • Address
  • Phone Number
  • Contract Web Site
• MSP
  • Insurer Name
  • Policy Number
  • Effective and Termination Date
  • Patient Relationship
  • Address
• Hospital/SNF
  • Location
  • Billing NPI
  • Admit Date
  • End Date
  • Discharge Status Code and Description

Moreover, the proper billing of the service date is emphasized, especially for items provided within two days before an anticipated home discharge. The discharge date must be appropriately billed in such cases. Payment cannot be processed by the DME MAC for items received during a beneficiary's Part A stay unless the equipment was delivered no more than two days before the anticipated discharge to home. Furthermore, insights into Home Health Episodes and Hospice information are available for reference.