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DME medical billing codes play a crucial role in filing the claims. With the right use of the right DME codes, you can assure of enjoying the higher rate of claims approvals. But if you don’t have clear-cut knowledge about the DME medical billing codes, you might face many claim denials. That’s why a lot of importance is given to the billing codes, as they help the insurer identify and measure the extent of the billing required for the procedures or DME equipment.
Therefore, the Healthcare Common Procedure Coding System (HCPCS) is the standard set of medical codes used by the medical institutions as per the American Medical Association’s Current Procedural Terminology (CPT). Out of the numerous commonly used codes, RR is a modifier used to identify the specific Durable Medical Equipment.
But what does RR stands for?
Durable Medical Equipment (DME) can be classified in the following ways:
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- NU – New equipment purchase
- UE – Used equipment purchase
The rental equipment uses the modifier RR that helps the insurer in identifying the equipment that is rented. In some instances, a DME would also be qualified as a capped rental item. This indicates that Medicare covers the initial equipment rental instead of equipment purchase. For covered items in Medicare’s capped-rental payment class, rental generally continues for up to 13 months of continuous use, after which ownership transfers to the beneficiary. This rule does not apply to every DME item; other payment classes and purchase options have different requirements. Confirm the HCPCS code, payment class, current fee schedule and applicable DME Medicare Administrative Contractor (MAC) instructions. See CMS DMEPOS payment policies.
Modifier RR identifies DME furnished as a rental when applicable. Modifier placement, rental-month modifiers and any required claim details depend on the HCPCS item and payer instructions. Confirm the current claim-line requirements with the applicable DME MAC; see Noridian’s DME modifier guidance.
Additional Modifiers used with RR modifier to indicate the rental period are as follows:
- KH- also known as the initial claim, used to indicate the first-month rental
- KI- used for identifying the second and third capped rental months
- KJ- used for determining the capped rental months of 4th to 13th
How to Calculate the RR Rental for DME?
Most capped-rental items: CMS describes a fee-schedule amount generally based on 10% of the average allowed purchase price for rental months 1-3 and 7.5% for later months. These are category-level percentages, not a universal rate for every DME rental. See CMS payment policy.
Some power-wheelchair capped rentals: Noridian lists a different schedule for applicable power-wheelchair rentals beginning on or after January 1, 2011: 15% for months 1-3 and 6% for months 4-13. Verify the HCPCS code, current fee schedule and jurisdiction-specific MAC guidance before calculating a claim. See Noridian’s capped-rental guidance.
The DME medical billers can calculate the RR rentals for the patients with the help of billing software. Also, various online websites have monthly rental calculators to help billers calculate the RR rentals easily.
When a Capped-Rental Period May Restart
An interruption does not automatically restart a capped-rental period. CMS explains that, for an interruption during a stay in a hospital or another facility that is not a qualified home, the prior period ends when the beneficiary’s medical need for the capped-rental item ends and the break exceeds 60 consecutive days plus the days remaining in the last paid rental month. A new period can begin only when the required documentation is submitted. If medical need continues during the facility stay, the period does not end merely because rental payments pause. Other equipment classes and interruption situations can follow different rules. Check the current CMS and DME MAC instructions for the item and circumstances. See CMS guidance on DMEPOS during inpatient stays.
When CMS criteria for a new capped-rental period are met, the supplier must submit:
- New medical-necessity documentation should support the DME claim.
- Inclusion of a new prescription by the ordering physician.
- A statement describing why the equipment was medically unnecessary while the beneficiary was in the facility.
These documentation requirements apply only when the applicable CMS conditions for ending the prior period are met. Because payment classes and interruption circumstances differ, verify the current rule for the HCPCS item, beneficiary situation and DME MAC before billing.
Things to Remember for DME Rentals
Equipment exchanges and modifications– For a capped-rental item, a new period after an exchange for similar equipment depends on whether the beneficiary’s medical need has substantially changed, not simply on equipment cost. Noridian states that without a substantial change in medical need, the current rental period continues. When an existing item is modified because medical need substantially changes, the original item’s period continues and a new period may apply to added equipment. Check the exact HCPCS item and DME MAC instructions. See Noridian’s capped-rental guidance.
Change of Suppliers– A change of supplier during the capped-rental period does not by itself start a new 13-month rental period. Confirm the remaining rental period and claim requirements with the applicable DME MAC.
Conclusion
Undoubtedly, the RR Modifier is of utmost importance for the claim forms and submission of the claims. Often, many denied claims end up identifying the issues related to the documentation or the modifier RR accuracy in the claim forms. As a claim submission largely depends on the thoroughness and accuracy of the biller, Info Hub Consultancy Services (ICS) trains their DME medical billers to go through every minute detail of the claim form and other billing details before forwarding them to the clearinghouse. Our experienced DME medical billing professionals are experts in their work, thereby reducing the claim rejections for enhancing revenue.
