When you are submitting a medical billing claim to an insurance carrier, probably the most important item as far as the carrier is concerned, is the item being billed. When all is said and done, that item is what is going to determine whether or not that claim gets paid. Why? Because even if an item is proven to be needed by the patient, if it is prescribed by a doctor who is not authorized to dispense that item, the claim itself will still be denied. What does this have to do with inventory files? Quite a lot, actually. In this installment we'll go over some basic things you will need to know when setting up your inventory files.
The main part of every inventory item is the item description. Many medical billing personnel don't realize that this field is not open to discussion. The item description MUST be the technical description as it appears in the Medicare, Medicaid, or private insurance manual. Even if one character is off, the claim will most likely not be paid. If this sounds nit picky, put a call into a US government medical agency and ask them if it's okay to use abbreviations. The reply you get will be much less than amiable.
Then there is the matter of the serial number, in the case of rental items. Medical billing personnel can't seem to understand what the big deal is if a serial number is incorrect, or worse, missing. Well, try getting a claim file through without one. Worse than that, try getting a replacement wheelchair when the one on the patient's property doesn't match the one that Medicare has in their files.
What most billers don't know is that most DME inventory file formats contain fields to hold the modifiers for these serial items. The subject of modifiers will be covered in detail in a future article. For now, what you need to know is that when a rental item is billed, not just the first month, but for every month thereafter, these modifiers are updated and restored in the file. If the modifiers don't pull correctly, or worse, don't even store in the first place, then the claim will be denied because of missing modifiers.
Your medical billing procedure gets even more complicated when billing items that are not in individual units, such as when you're billing something that's either in a box or a case. What does this have to do with inventory? Well, most DME inventory files have what is called an item type field, which designates whether the item is a single item, box item of case item. A case item is an item that contains multiple boxes. When you submit your bill, if it is for one of the item types that is not a single item, the software has to go through a conversion because most medical billing carriers require all bills to be submitted in units. The subject of conversion will be covered in more detail in another installment. All this information, however, has to be stored in the inventory file.
And this only scratches the surface. Inventory files are quite complex and a large percentage of what goes into a medical bill depends on these files. So it is critical that you make sure that they are setup correctly.
