Changes to ADvantage Home Delivered Meal (HDM) and Durable Medical Equipment (DME) Service Authorization
Billing errors result when a Provider Agency is paid for services provided outside of authorized service dates. These most commonly occur when HDM and DME Providers are not aware their services are either ending or changing. This end/change in services can be a result of a change in either the Member’s service needs or the Member’s status. When a change in the Member’s service needs prompts a service to be ended on a Service Plan Cost Sheet Addendum, the HDM/DME Provider must be informed prior to the service line end date to avoid billing issues. One of the primary responsibilities of the ADvantage Case Manager is service coordination. As such, it is the Case Manager’s responsibility to notify all Providers when their services need to be changed or ended.
Effective immediately, we are requesting Case Managers begin using future end dates of at least two (2) weeks for all ending/changing HDM and DME service lines. The use of future end dates will ensure all providers are notified in a timely manner.
For issues related to member death or Nursing Facility placement, the Provider should be notified as soon as the Case Manager is aware of the event.
All Service Plan Cost Sheet Addendums that have been submitted prior to this bulletin will be processed as submitted. All HDM and DME service line changes received with a submit date after 07/18/2013 will be administratively adjusted to end effective the date of authorization.
Please note: If services are provided outside the dates of the authorized 6g, the Provider will not receive payment.
Compliance with the above requirement will drastically reduce the number of billing errors received, reviewed, and processed at the AAU on a daily basis.
If you have any questions regarding the information provided above, please contact us at Provider Questions via your Smarter Mail account.