Regulatory Assistance

Unfortunately, regulatory threats and issues are real and can put your business in serious jeopardy.

As a U.S. Rehab member, you will benefit from our team of reimbursement specialists and regulatory experts to keep you updated on new regulations and compliance issues for the DMEPOS industry, competitive bidding, HIPAA, accreditation and other areas.

Our team are not only expert researchers, but also regularly attend industry events. They give you the knowledge and tools you need so that you aren’t facing any regulatory pressure on your own.

 

Hot Issues

Capped Rental Repairs Items (with RB modifier) to Pay as Lump Sum with DOS on or After Oct 1

Oct 26, 2016

For dates of service on or after Oct 1, all repair parts / accessories billed with the RB modifier must be sent with NU. If you submit a repair code with RRRB, it will reject! This change does not affect the payment category as they remain in as a capped rental; however, when billed as a repair with the RB, they will now be paid on a lump sum basis regardless of the base code (complex and non-complex). 

Capped Rental Repair (RB) Items in Rental Process (prior to Oct 1 date of service)

If you were already renting a capped rental part / accessory, such as a motor (E2370), and the October date of service would be the 4th month, for example, that month DOS would replace the RR with NU and add the KH to the other modifiers (RB, KX, RT/LT if applicable). For the Oct date of service, the submitted charge should be at least the remaining amount for the purchase allowable (first month rental amount on the fee schedule divided by 0.1) minus the allowable they already approved for the first three months. 

Example (using 2016 allowable 4th quarter in Texas)

  • E2370 paid 3 months as a rental (July, Aug and Sept) @ $49.77 per month for a total of - $148.41
  • In month 4 (Oct DOS) the remaining amount as the purchase allowable should be billed NOT the monthly or they will only allow 80% of the submitted charge!
  • Total purchase allowable - $497.70 - $148.41 = $349.29 (should be the minimum submitted charge with the Oct DOS)

New Capped Rental Repair Items (date of service on or after Oct 1)


New repair code claims with DOS on or after Oct 1 will be paid as a purchase. Use NU in place of RR along with the NUKHRB and of course:

all other required modifiers (KX, LT/RT, etc. when applicable) and bill the total purchase allowable (fee schedule rental amount divided by 0.1) or your usual and customary charge (MSRP). Reminder - If your submitted charge is less than the allowable Medicare will only allow 80% of the submitted charge.

Example (using 2016 allowable 4th quarter in Texas)

  • E2370 purchase allowable - $497.70 (at a minimum) submitted charge for Oct DOS or after

Note:

  • Capped rentals can only have 1 unit per line item

Attachments

* CR 9579 regarding repairs on and after Oct 1 DOS

* LT RT Modifier Usage


 


   

Providing Solutions for Complex Rehab Providers