What is CPAP Billing?
Continuous positive airway pressure (CPAP) is a therapy used for obstructive sleep apnea. When you buy machines from somewhere like CPAP direct for your patients, it is important to know that every insurance provider is different and may not accept HCPCS related codes for all CPAP-related equipment. CPAP billing is the process of performing all the front or back end work including verifying the patient’s eligibility, prior authorization, order entry, doctor’s office follow up, claims submission, denial management, accounts receivable collections, payment posting.
It is important to note that CPAP compliance is a critical aspect of getting reimbursement and has to be used for at least 70% of the nights which is equivalent to 4 hours of usage. Medicate considers first 90 days as a trial period.
The documentation of compliance begins after the 31st day of usage. All documentation must be done between day 31 and 89. After 3 months if the patient does not prove the nightly usage of CPAP, Medicare does not cover the costs. Hence the CPAP billing activities should also be visited by the compliance calls or counselling calls made to patients as it directly influences your collections as a supplier.
What is BIPAP billing?
As the name suggests, it is a two way machine and acts as a ventilator and helps in pushing air into your lungs. While CPAP in general delivers single pressure , BIPAP has the possibility of delivering two. The two are known as inhalation positive airway pressure (IPAP) as well as exhalation positive airway pressure (EPAP). BIPAP billing also involves the same process of doing all the work with eligibility checks , prior authorization, following up with the doctor’s office for documents, intake of order and confirmation, claims submission, denial management and accounts receivable collections.
The Sunknowledge Advantage in CPAP Billing
Sunknowledge has the precise understanding of what it takes to deliver actionable support in CPAP billing. We have set benchmarks, provided support in both pre and post billing to some of the largest names in the DME business. Also, we have worked with companies dealing with respiratory products including CPAP items and provide both after sales and all support with patient calling.
In fact, we have been exceptional with our CPAP compliance activities and have raised rate of compliance for the best from 40% to 80% for the biggest and the best. Our tam understands what it takes to deliver it all with eligibility verification, prior authorization, doctor’s office follow up, order entry, claims submission, denial management , accounts receivable collections, payment posting.
Apart from them we also do compliance activities tracking patient use, asking them to comply as per Medicare guidelines so that it reciprocates to better collections for our clients. We offer complete CPAP billing for $7 per hour and have excellent references from the leading clients across the country. In short, we are your ultimate operational arm, offer you streamlined support and customized reporting as per your tailored needs. We have over a 100 clients only in the DMEPOS space and have complete versatility across all major practice management systems.
Also, we work according to your time zones, offer resources with whom you can get in touch any time. Also, we provide a free transition approach to understand your process and have the unique ability to perform as a full service extension. To conclude, Sunknowledge is surely one of a kind in the competitive landscape.
Complete CPAP Machine Billing and BIPAP Machine Billing
As a powerful healthcare services company, Sunknowledge Services Inc caters full support in front as well as back end revenue cycle management. The best part of working with us will always be our unique support in pre billing that lays down a strong foundation for a stronger recovery of cash by working as your reliable operational extension. We are currently working with over 100 clients in DMEPOS as well as across the HME industry with excellent references.
We offer a host of solutions and are currently working with leading DME and Orthotics & prosthetics providers both in the east & the west coast.
Our Pre-billing Services:-
♣ Eligibility Verification – Online & Calling (with same & similar check for Medicare)
♣ Authorization Initiation – Online & Calling
♣ Authorization Follow Up
1. Follow-up with the payer on Authorization
2. Completion of authorization form based on the outcome of the request
Doctor’s Office Follow-up for documents etc
Re-Authorization
Order Entry
1. Patient Account Creation
2. Patient’s demographic entry
3. Prescription information entry
4. Insurance entry
5. Provider’s information entry
6. Item entry
7. Order Confirmation
8. Scheduling of Delivery
Post-billing Services:-
♠ Creation of Claims
♠ Claims Submission
1. Primary/Secondary/Tertiary claim submission (via paper/fax/electronic)
Claim Rejection Management
1. Online rejection checking (via Clearing House)
2. Correction and re-submission of the rejected claims (via Clearing House)
Payment Posting – Auto & Manual
1. Patient payment posting and adjustments
2. Insurance payment posting and adjustments
Accounts Receivable & Denial Management
1. Follow-up on pending AR balance and working on denials
2. Follow-up on possible reconsideration requests
3. Filing reconsideration requests & appeals
Also, we have extended our scope of work in following activities:-
♣ CPAP User Compliance tracking and support
♣ Patient Collections
♣ Re-supply processing
♣ Hold projects (CMN/PAR etc.)
♣ Fax / documentation indexing and management support
Looking for a powerful action plan in CPAP billing and BIPAP machines billing, we are a call away! Let our team share with you our experience, ability to offer complete billing support across all respiratory items. We are a one-stop CPAP billing and BIPAP machine billing company!