Repair Reminders

By Dawn Best
 
As we settle into the start of the new year, I wanted to share best practices for repairs to help minimize the number of documents needed, denials received, and to keep a short transaction cycle.  Here are a few helpful reminders to ensure our clients receive excellent care and quality service:
 

* Coding, Coding, Coding:  It is our best practice to review orders for accuracy the very first time we step into an order, regardless of who may have worked it previously. Many parts may be coded the same, but have different descriptions, making it difficult to identify the correct HCPCS code. We cannot use K0108 or E1399 in place of an assigned HCPC code for better reimbursement.  Some valuable resources to help identify correct HCPCS codes are PDAC, Find-a-Code, the Accessory Coding Reference, Supplier quotes or enlisting the help of your teammates or Lead.  If your team has a Teams group chat, this is another great resource to gain helpful insights.

 
Helpful Hint- Use OneNote to create a coding page for difficult parts.  Copy and paste the description of the part(s) and paste onto the coding page in OneNote. Next to the description, document the confirmed HCPCS.  That way going forward, when coding, search by the description and boom, there’s the code!  Don’t forget to share this with your leader so we can create master resources that can be shared, or even better, so we can update the suggested code in Mobility Advisor to reflect the correct HCPC based on NCCI guidelines.  
 
Units and Pricing: When reviewing detail, before creating a Repair Rx, verify accuracy of Units and Pricing. If there is a quote scanned, we may see a difference between what is on the quote vs detail.  As an example, you may see Quantity of 1 each in the order detail but a closer look at the supplier quote reflects, “Pair”.  In this case, we need to update the Unit type for this item to Pair and update the order to ensure we have the correct billing quantity which may change from 1 Each to 2 Each in this example. Once updated, select Reset All Lines in the Detail screen to capture the correct reimbursement. 
 
Labor Detail Report:  For Payers to determine if repairs are justified, they need to understand what we are requesting and why.  The Labor Detail report can be helpful as having this information initially will help reduce the number of deferrals received, which is why we should also review for accuracy prior to sending this report to the payer. If order detail shows we are replacing arm pads, arm rests, and wheel locks, however, the Labor Detail Report only shows justification for the arm pads, to prevent deferrals or denials, it is recommended to secure the missing the repair justification for the wheel locks and arm rests prior to generating the Repair RX.
 
Repair Rx: To improve efficiency, we have the Repair Rx as a Hot button document within our Scan Docs. This reduces the number of documents needed by combining a Rx and Labor Justification. Simply select the Repair Rx hot button and review Coding, Physician information, Equipment we are repairing, and the Repair Justification sections for accuracy.  We may notice that some of the repair justification is not visible due to the number of parts or items that we may not be able to bill the payer for such as diagnosis, safety checks, and training. Correct this before sending by updating Labor to uncheck boxes that are not billable or manually formatting the justification area to ensure all repair justification is visible. With extensive repairs that may still require a separate Labor Documentation form, ensure to add the document requirement as a (S) document and once scanned into the work order, satisfy the requirement to ensure it is included in our submission documentation.
 
Bases under a Rental Period: Usual and customary repairs are not covered by most insurance plans whenever the equipment is actively under a 10- or 13-month rental period since the equipment is considered under NSM’s ownership. In this scenario, NSM is responsible to complete repairs to ensure equipment is in good working order which means usual and customary repairs are at NSM’s expense. The time frame of a rental period varies depending on the Payer as outlined in the payer’s UPD.  Whenever we have a repair order that falls within the rental cycle timeframe, ensure to follow the steps outlined in our Resource guide on WNSM.  A best practice is to send a note to the Service Manager or Branch Manager to bring awareness.
 
I hope you were able to find this information useful.  Anything we can do to reduce the cycle time for repairs is always in the best interest of our clients.  As always, please feel free to reach out to your Lead, Supervisor, or myself with any questions.  Thank you!