DME/P&O billing changes for URMBT will take effect Jan. 1

As we discussed in the November edition of The Record, Blue Cross Blue Shield of Michigan will begin managing benefits for auto group and UAW Retiree Medical Benefits Trust members who use DME/P&O services provided by professional DME/P&O suppliers, starting Jan. 1, 2014. This change does not affect DME/P&O services that are rendered in and billed by a hospital or physician’s office.

The URMBT benefit states that the payment policy for its members’ durable medical equipment and prosthetics and orthotics services must follow Centers for Medicare and Medicaid Services guidelines.

To ensure that DME/P&O providers are following CMS guidelines for non-Medicare URMBT members, Blue Cross is requiring providers to bill with a KX modifier on all claims with dates of service on or after Jan. 1, 2014, for the HCPCS codes listed below. The KX modifier indicates that providers have all documentation needed to show compliance with CMS guidelines in the event of a claims audit.

DME/P&O claims billed with the following codes will be denied as a provider liability if they are missing the KX modifier:

Please contact your provider consultant if you have any questions.