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Back  RFI # 1287: HIPAA Code Set Violation - DME

Formal vs. Informal Help Informal Formal

Submitter

Denise Page

Description

Are there any HIPAA Code violations if we are creating code for Oxygen related DME, from and through Date to be the same?

Per CMS- DME can be billed with from different from and through dates. (published policy)
Per BCIProvider Policy- Oxygen related DME should be billed with the same from and through dates. (published policy PAP)
Medicare (policy)- Oxygen related DME should be billed with the same from and through dates. (published policy)
Medicare (practice) is allowing Oxygen related DME to be billed with different from and through dates.

Can BCI restrict the from and through dates to be the same?

The coordination of benefits claims that we BCI are seeing are primarily coordinating with Medicare. The providers are billing Medicare different from and through dates. Medicare is allowing this practice.

Submitter Assigned Keywords

DME

Response

The 837 Professional Implementation Guide allows a single or range of service dates, and further allows a "range" where the To and From dates are the same. It is outside the scope of the implementation guide to set rules on what dates are reported for specific services, such as the oxygen related DME questioned in this request.
Submission 3/31/2011
Status Date 6/1/2011
Status F - Final
Primary References
Document 004010X098
SectionDATE - S
Page435
Set ID837
Loop2400
Segment PositionDTP
Element Position02