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:
- RR – Rental
- 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. It generally arises when the equipment involves a huge cost. Moreover, Medicare will bear the rental fees for the equipment in monthly installments, and any DME can be rented for as long as it is a medical necessity. For instance, if a patient rents a DME for 13 months, the ownership of the equipment will automatically get transferred to the patient.
It is important to consider that the modifier RR is used for billing and collections by the DME medical billers. Also, it is crucial to mention the RR modifier in the claim under the location of the first modifier. If you miss using such an RR modifier, the claim will not be processed correctly as a purchased item. The form should also include the starting and the end date of the rental cycle to ensure proper processing of the DME claim.
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?
For the First Three Months – The rental fee is restricted to 15% of the average purchase price that is allowed for a piece of new equipment during the base period. This value takes into account inflation.
For the Rest of the Months (4-13) – The monthly rental is computed at 6% of the average purchase price allowed for the equipment.
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.
Claim Forms for Resuming Rental after a 60-Day Interruption
After 13 months, the ownership of the equipment will automatically transfer to the patient. In case of any interruption in the usage of the equipment and if such interruption period exceeds 60 days, the use of the rental equipment is considered to be ceased. However, if the patient acquires the rental DME again after a gap of 60 days, a new 13-month rental will again be initiated as per the rental terms and conditions.
In case an interruption is caused, and a new 13-month RR rental claim is put through, the DME medical billers must keep in mind the following:
- A new certificate of DME medical necessity should support the DME claim.
- Inclusion of a new prescription by the ordering physician.
- A statement documenting the interruption reason should be mentioned with the claim.
The DME medical billers must be thorough with the claim, especially if a client is resuming the rental after a gap of 60 days. Such claims often go through detailed and careful scrutiny and require adequate documentation along with the most accurate information to support the claim. In case of any missing documentation, the claim can be denied easily.
Things to Remember for DME Rentals
Modifications in the Equipment – If a patient modifies the equipment, there is a possibility for entering a new 13 month rental for the additional equipment. This is generally decided based on the modification extent. If the modification is minor, then the 13-month rental will continue for the primary equipment without any new rentals for the modification. But if there is a major change in the equipment that involves a high cost, then a new 13-month rental for new equipment will be added to the existing 13-month rental for the existing equipment.
Change of Suppliers – If the patient chooses to change the equipment suppliers for the rented equipment, a new 13-month rental will also begin for the rented equipment from the new supplier.
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.
