Home Health & Hospice Week

Remember: You can't bill for supplies that haven't been coded.

A backlog of manufacturer requests at the SADMERC could wreak havoc on your durable medical equipment claims if you're not careful.

The Statistical Analysis Durable Medical Equipment Regional Carrier has been so overwhelmed with coding requests that it's posted a notice on its Web site telling manufacturers that it's unable to answer certain requests within its usual response time of 90 days.

What that means for suppliers: While the backup has the most direct impact on manufacturers, it could still create problems for suppliers down the road.

"It ripples down to have an effect on the suppliers if they're not paying attention and they try to bill for something that's not been coded," says Peggy Walker, a reimbursement specialist with VGM Group in Waterloo, IA.

The Centers for Medicare & Medicaid Services reported the coding delay problem at the April 21 Open Door Forum for home care and DME providers.

"There are some people who are just sending in entire catalogs that don't necessarily need to be coded right away," said a CMS official in the forum. "They were just getting swamped."

For now, the SADMERC is asking manufacturers to refrain from calling for status updates. The SADMERC is also asking manufacturers to prioritize the requests they send so it can respond to the most critical needs.

"The SADMERC will not perform reviews of entire catalogues," it warns on its Web site.

New Wheelchair Codes Take a Toll

A factor contributing to the SADMERC's heavy workload is HIPAA-mandated use of the national HCPCS codes for DME, prosthetic and orthotic supplies to all insurance carriers.

And the workload isn't likely to lighten any time soon, as CMS' current coding initiative for power wheelchairs means the contractor will have to match existing power mobility equipment with 49 newly introduced billing codes before they take effect next year.

"These items are going to have to be coded by Jan. 1, and the manufacturers are just now starting to put them in," Walker points out. "If they don't get coded by Jan. 1, the manufacturers aren't going to be able to sell them."

Getting the wheelchairs coded is a top priority for the SADMERC, a CMS official said in the forum. Once that work gets underway, coding delays will probably last for a few months, but the SADMERC should be "back on track" by the end of the year, she added.

Editor's Note: The SADMERC notice is at www.palmettogba.com/palmetto/Other.nsf/Home/Other+Medicare+Partners+SADMERC+Home?OpenDocument.