Medical Billing and Coding Healthcare Blog

The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to organizations concerning Medicare payment for positive airway pressure (PAP) devices.

CMS notes that the Social Security Act prohibits payment for devices used to deliver continuous and/or bi-level PAP as items requiring frequent and substantial servicing, regardless of the illness the device is being used to treat.

Claims submitted for payment for such devices will be denied.

CMS goes on to state that using HCPCS codes E0450, E0460, E0461, E0463, E0464, E0465 or E0466 on a Medicare claim for a device to deliver PAP to a beneficiary is not allowed and could potentially violate the False Claims Act, even if the same device could be used as a ventilator for a different beneficiary.

Governors from multiple states (including Alabama and Virginia) have declared March 31 to be Medical Biller's Day for 2016.

A portion of the proclamation from Alabama reads as follows:

"WHEREAS, Medical Billers provide a much needed service to doctors and other healthcare providers and provide a vital segment of the health care industry; and

"WHEREAS, increasingly, health care providers rely on Medical Billers and Medical Billing companies to assist them in processing claims in accordance with applicable statutes and regulations. Additionally, health care providers consult with medical billing companies for advice regarding reimbursement matters, as well as overall business decision-making; and

"WHEREAS, Medical Billers strive to provide a high level of ethical, lawful and professional conduct throughout the entire health care industry; and

"WHEREAS, Medical Billers offer expertise in carrier reimbursement requirements, help ensure that medical claims are accurately prepared to free physicians and other practitioners to devote their energies to the care of their patients; and

"WHEREAS, Medical Billers continue to influence the medical billing process in a positive and credible manner and should be recognized for their efforts and their loyalty to the Medical Billing Profession."

PGM Billing would like to wish our medical billers and billers nationwide a happy Medical Biller's Day!