Home Health & Hospice Week

You may need to get more careful about using KX modifiers on your DME claims.

Background: Medicare requires you to append modifier KX on certain durable medical equipment claims to indicate that the claim meets Medicare coverage criteria and the supplier has the required documentation on file.

Audit findings: The OIG sampled 400 claims with modifier KX on them, but only 163 actually had the required documentation on file, according to a recent OIG report. The OIG estimates that CMS "paid approximately $316.4 million in unallowable Medicare payments to suppliers."

Among the errors were missing physician orders (37 percent of the problematic claims) and no proof of delivery (21 percent).

Look for increased scrutiny: As a result of the audit, the OIG has advised Medicare to institute additional safeguards for DME claims, such as prepay and postpay reviews. The report is at http://oig.hhs.gov/oas/reports/region4/41004004.pdf.