MO HealthNet Provider Hot Tip of the Week
Manually Priced Durable Medical Equipment
May 20, 2013
The majority of all items in the MO HealthNet Durable Medical Equipment (DME) program have an established allowed amount; however there are items that continue to require manual pricing. Section 19 of the MO HealthNet DME provider manual contains a list of all covered procedure codes. Manually priced items are noted in the “Allowed Amount” column with a ‘MP‘ and in many cases have ‘IOC’ (Invoice of Cost) in the “Reimbursement Guidelines” column.
In order to price these claims correctly, providers need to provide accurate and up-to-date information. An invoice of cost can be submitted electronically through an attachment within the CMS-1500 claim form on the eMomed billing web site or may be submitted as a paper attachment to the CMS-1500 claim form. Orthotics, prosthetics, ostomy supplies, HCY items (Healthy, Children & Youth), and any other item requiring an invoice, is reimbursed at the provider's cost plus 20%. Should a provider bill their actual cost and attach a valid invoice, MO HealthNet would only reimburse the provider their cost as the system cannot reimburse a dollar amount greater than the provider's billed amount. Examples are provided for your convenience.
- Unit Cost - $100 Billed Charge - $150 Reimbursement - $120
- Unit Cost - $100 Billed Charge - $105 Reimbursement - $105
Please keep in mind a provider’s billed charge should be their usual and customary charge to the public.
2013 Archived Hot Tips
- Essure Product Reimbursement
- Professional Same-Day Services
- Recovery Audit Contractor Sends Out Initial Overpayment Letters; RAC Contact Information
- Claim Submission for Procedures Performed Multiple Times on the Same Date of Service
- Using Locum Tenens
- Instructions for Submitting Provider Enrollment Documentation
- Suggestions for On-line Training Conferences
- Proper Paper Alignment—UB-04 and CMS 1500
- Reminders for Securing and Protecting Data—Emails
- Encrypted E-mail
- Vaccine for Children Program
- Choosing the Correct Claim Form
- Invasive Ventilators, E0450 & E0463
- Suspended Claims
- Reminder—Filing Medicare Denied Claims
- Adult Dental Criteria
- Updating Provider Enrollment Information
- Provider Update Meetings
Older Archived Hot Tips
The MO HealthNet Division provides weekly tips to providers to assist them in receiving timely reimbursement for services provided. As each new tip is posted, existing ones are archived on the same site for easy reference. Please share these weekly tips with your billing staff.