2, 4, 10, 13, 15, 22, 36. What do these numbers share in common? They’re all essential figures in billing Medicare for recurring rentals.

Two – rent / purchase option letters sent prior to billing for rental month two (2) for those items required by Medicare policy. What are those items? Electric wheelchairs, Parenteral and Enteral Nutrition pumps. The Medicare supplier manual indicates “The beneficiary has the option of purchasing an electric wheelchair (or PEN pump), with the initial claim”, and in the case of PEN pumps “at any time during the rental period.” CPR+ handles these items by producing rent purchase option letters for these items at the time of the first monthly billing. These letters will be produced for any item that has the “Requires Rent/Purchase Letter at 1 Month” question in the inventory item setup answered “Y”.

Four – according to the Medicare policy manual any item that falls into the capped rental payment category is subject to a 25% rental allowance reduction for months four (4) through thirteen (13). CPR+ will take this reduction automatically based on the program options setup. This option is located in the Utilities, Program Options, Billing/Financial options, question number nine (9) “Decrease Capped Rental Expected Amounts Beginning Fourth Month”. It is important to note that this 25% rental allowance reduction does not apply to PEN Pumps.

Ten – according to the Medicare policy manual any item that falls into the capped rental payment category, and was provided prior to January 1, 2006, “Suppliers must give beneficiaries the option of purchasing the equipment during the 10th month of continuous rental”. This requirement is not necessary for any capped rental service provided to a Medicare beneficiary on or after January 1, 2006. The exception here is again with PEN Pumps, because these items may be purchased at any time during the rental period. The purchase option letters will generate during the invoice creation process for month 10.

Thirteen – the magic number. The capped rental items payment policy states “Items in this category are paid on a monthly rental basis not to exceed a period of continuous use of thirteen months.” CPR+ will generate thirteen monthly rental claims and then will change the status of the item to “Sold”, put the item “out of service” in the Inventory and remove the item from the Recurring Rentals Manager. This occurs automatically for any item that falls under the capped rental payment policy; no user intervention is necessary.

Fifteen – the maximum number of concurrent monthly rentals that can be paid for a grandfathered caps rental item or a PEN Pump. After the fifteenth month has been billed, CPR+ will prompt the user to move these items into a maintenance status.

Nineteen – the first billable maintenance month for a qualified service on a PEN pump. “For parenteral pumps, the DME MAC pays no more than 1/2 rental payment every three months, beginning three months after the last rental period for the pump. The supplier should keep written proof of maintenance and servicing of the pump on file.”

Twenty-two – the first billable maintenance month for a grandfathered capped rental item. CPR+ will produce a bill for these items starting in month 22 and for every six-month period (28, 34, 40, 46, 52. . .) until the beneficiary no longer demonstrates medical necessity for the item. If a user is attempting to produce a claim for a capped rental item and the billing month number does not fall within the calculated number of months, CPR+ will not produce the claim. The user must correct the month number in order for CPR+ to produce a rental claim.

Thirty-six – The End-of-the-Road. “Section 5101(b) of the Deficit Reduction Act (DRA) of 2005 established a 36-month (three year) limit, or cap, on monthly payments for stationary and portable oxygen equipment.” CPR+ will cap oxygen equipment after the 36th monthly rental has been reached
(i.e., when the user attempts to bill for month 37).

So why all the numbers? These numbers are hard coded into the Recurring Rentals Manager in CPR+. Essentially CPR+ has studied and memorized the Medicare payment policy manual. This is an important item. What it means to the user is that once an item is set up in the Recurring Rentals Manager, the user need not touch that item again barring the changing of the serial number, CMN assignment, authorization assignment, or Billing End Date.

If your organization has not yet upgraded to CPR+ version 8, you’re missing out on a very powerful and organizational workflow tool: the Recurring Rentals Manager. This manager allows the biller to filter the list of recurring rentals by: Payor, Status, Biller, specific Item, and Next Bill date range. These filters enable the biller to work on specific items. For example, if the biller wishes to see only those items with a status of “Active” that are assigned to Medicare, this action could be accomplished through use of the new filters.

The Recurring Rentals Manager also honors these filters when invoices are created. So, using the previous scenario, this biller could create invoices for active items assigned to Medicare only. No other invoices for other statuses for other payors would be created. This is one of the best advantages of using the filters. Previously, when invoices were created, CPR+ would produce claims for any active, maintenance, or sold status item that fell into the selected date range.

Recurring Rentals FAQ’s

Why are the modifiers wrong when I look at a rental item setup?

The item setup displays either the first month default modifier(s), or the modifier(s) that were used on the last claim created. This can sometimes be confusing when a user changes a payor, or is looking at a month number that would necessitate a change in modifier. CPR+ generates modifiers when the claims are created (based on the billing month number). This means that even if the user knows how to change the modifiers on the screen, CPR+ will over-write these when the claims are generated.

How does CPR+ determine the pricing of a rental item?

CPR+ determines the pricing of the rental item at the time that the item is setup. Pricing is taken from the Inventory item, or Special Price Matrix of the payor that is assigned to the item. Keep in mind that if the price is manually changed, CPR+ will change it back to the default value if the item is edited again.

Why do I still get warnings about non-billable services on my Medicare capped rentals?

The first step in troubleshooting is to make certain that the “10th month letter sent” question is only answered for those items that had a rental period that began prior to January 1, 2006. Most often, a letter was generated when it was not required and CPR+ is seeing contradicting information.

Why do I get a warning when billing maintenance when I know that I’m in a billable maintenance month?

This is usually the result of a counting problem. If the rental period begins on February 24, 2008, the claim for February 24, 2009 is the 13th month’s bill, not the 12th. In the same manner, February 24, 2010 is only 12 months counting after the 2009 claim. The first year’s billing ends on February 23, 2009, so the next day begins the 13th month.

When does CPR+ assign a “Sold” date?

When the DRA changes were first put in place, the “Sold” dates were populated immediately. Subsequently, the programming was changed to populate the “Sold” date at the end of the rental period. This action ensures that the proper serialized piece of equipment is being sold to the patient.

For more information and detailed training, please see the on-demand class on Recurring Rentals found at http://ondemand.cprplus.com.

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By Jeff Johnston

Last week, D.H.S. attended the B. Braun National Sales Meeting in Phoenix, Arizona.  In attendance were over 300 B. Braun sales representatives from all over the country.  Kelli Berzett and I did an overview of CPR+ and a detailed demonstration of the new Pinnacle TPN compounder for the Home Infusion Sales Force.  We also participated in a hands-on session with the Pinnacle compounder, seeing the barcode-based interface in action. 

Developed in 2007 and now used in production by several home infusion providers, the CPR+ / Pinnacle interface saves the pharmacy time and increases patient safety by eliminating the need to manually enter the TPN formula (number of milliliters of each ingredient) into the compounder.  After the TPN calculations are performed by CPR+, a two-dimensional bar code is printed on the TPN Worksheet.  This bar code is read by a wedge scanner attached to the Pinnacle Compounder, which then transfers the formula to the compounder.

We’re pleased to be the exclusive vendor offering a direct interface to this innovative and time-saving device.  We’ve talked to our customers who are using the CPR+ / Pinnacle interface and they love it.  If you have questions about how to implement this enhancement in CPR+ v8.0, contact Kim Carlsen today at 866-277-4876.

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