Remark code M113 indicates that, according to the records, the patient started using the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) before the current contract period under the DMEPOS Competitive Bidding Program. This could impact reimbursement as the item or service may not be covered under the new contract terms.
Common causes of code M113 are:
1. The patient started using the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) before the effective date of the current competitive bidding contract.
2. There is a discrepancy between the date of service provided in the claim and the actual start date of the patient's use of the DMEPOS.
3. The claim was submitted without proper documentation to reflect the correct start date of the DMEPOS usage.
4. The healthcare provider may have failed to update their records to align with the new competitive bidding contract period.
5. There could be an error in the billing system that incorrectly flagged the claim based on the date of service.
6. The provider might have inaccurately coded the date of service, leading to a mismatch with the competitive bidding program's contract period.
Ways to mitigate code M113 include ensuring that the patient's start date for using the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) is accurately documented and aligns with the current contract period of the DMEPOS Competitive Bidding Program. It is essential to verify the patient's eligibility and the start date of the contract period before submitting claims. Additionally, maintain open communication with the DMEPOS supplier to confirm that the equipment or service provided falls within the competitive bidding contract terms. Regularly review and update records to reflect any changes in the patient's equipment or service usage to prevent discrepancies that could lead to this code being applied to future claims.
The steps to address code M113 involve verifying the date of service and the initiation of the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) with the patient's records. If the date of service is indeed outside the current competitive bidding contract period, you should check for any grandfathering provisions that may apply to the patient's use of the equipment or service. If the equipment or service is covered under such provisions, document this and resubmit the claim with the appropriate justification.
If the date of service is incorrect or if there has been a mistake in the patient's records, correct the information and resubmit the claim with the accurate dates. In cases where the patient was not covered under the competitive bidding program at the time the DMEPOS was initiated, you may need to contact the payer to discuss the specifics of the case and determine the correct billing procedure, which may involve submitting the claim to a different payer or through a different process.
Additionally, ensure that all future claims for DMEPOS are in compliance with the competitive bidding program requirements and that the initiation dates for any new equipment or services are within the contract period. Educate staff on the importance of verifying coverage periods and competitive bidding program rules to prevent similar issues from occurring in the future.