DME Billing

Providing billing services for Durable Medical Equipment (DME), or Home Medical Equipment (HME) as they are sometimes called, can be a time-consuming and tedious affair. Among other things, it requires in-depth knowledge of reimbursement guidelines of Medicare, Medicaid and Commercial Plans, and their caveat. It also requires a constant adherence to quality and staying abreast of all the changes happening in reimbursement regulations and coding & documentation requirements.

Sunknowledge has a highly capable team of DME billing experts who can make life easier for you from the very first day. With Sunknowledge by your side, you can leave all your DME billing worries to expert care. Outsourcing your DME billing requirements to us will allow you and your staff to concentrate on marketing, growing and running business operations, rather than managing a billing and collections department.

Our experience shows that the process for DMEPOS billing can be cumbersome due to its inherent nature, viz. the order getting generated from a physician’s office. This increases complications and the turn-around time as dependencies increase. DME, Prosthetics & Orthotics companies need to devote much time coordinating and communicating with the ordering physician’s office for a valid Rx, medical/therapy notes, etc. Equipment that requires prior authorization also involve innumerable follow-up calls. This is managed effectively by us through our methodical and streamlined process that tracks each request in detail ensuring timely follow-up. Payor guidelines are specific to diagnosis and a thorough knowledge of this result in drastically reducing denials. Our diligent physician and payor follow-up activities also help reduce turn-around time and improve cash flow. The process starts with entry of orders and ends when the account has zero balance. This includes conducting eligibility checks, obtaining authorization, creating sales orders, scheduling delivery, submitting claims, managing rejections and denials, and proactively following-up AR.

Highlights

  • Follow-up on incomplete prescription with physician’s office
  • Follow-up for document collection (diabetic verification forms, LMN, CMN etc.)
  • Error free patient entry
  • Error free sales order creation
  • HIPAA compliant
  • Real time transaction audits
  • Primary and secondary insurance verification
  • Insurance verification for rental items
  • Obtaining authorizations & extending authorization
  • Open order audit and clean-up
  • CPAP user compliance tracking and counseling calls to non-compliant patients
  • Claims submission within 48 hours of receiving proof of delivery
  • Rejection follow-up within 24 hours
  • Tracking and follow-up of partial or incorrect payments
  • Denial management based on detailed analysis
  • Methodical and proactive AR follow-up
  • Timely payment posting to reflect accurate AR
  • Customized reporting
    • Claims submission
    • Collections
    • Denials
    • Accounts receivables

Our Complete Approach to DMEPOS Billing

  • Initial Visit Appointment Setup (done by Practice)
  • Order Entry
    • Patient Account Creation
    • Patient’s demographic entry
    • Prescription information entry
  • Initial Eligibility Verification
    • Creation of Insurance verification form
      • Checking general eligibility and benefits information and updation in OPIE
  • Initial Evaluation Appointment (done by Practitioner)
    • LCodes assignment
    • Measurements (If required)
    • Creation of Evaluation form/Notes/Other Medical Records
  • Detailed Eligibility Verification & Authorization Requirement Checking
    • Re-verification of eligibility with assigned codes
      • Updating detailed code specific benefit
    • Checking authorization requirements (Code Specific)
    • Creation of Service Estimates (Payer Specific and Reasonable and Customary)
    • Sending detailed written order/diabetic verification form and other paperwork to doctor’s office for signature
  • Doctor’s Office Follow-up
    • Contacting doctor’s office for pending detailed written order/diabetic verification form and other paperwork
  • Authorization/Pre-Determination/Referral Initiation
    • Creation of Insurance Authorization Form
    • Requesting Authorization/Pre-Determination/Referral (Via Phone/Fax/Email)
  • Authorization/Pre-Determination/Referral Follow-up
    • Follow-up with payer on Authorization/Pre-Determination/Referral status
    • Completion of authorization form based on the outcome of the request
  • Final Eligibility Verification or Pre-delivery Check
    • Creation of patient financial responsibility form
    • Notes updating
    • Work In Progress (WIP) updating
  • Office Coordinator Notification
    • Patient responsibility
    • ABN creation
  • Schedule Delivery
  • Delivery (done by Practice)
    • Signing Delivery Ticket (Soft copy/Hard copy)
  • Claim Submission
    • Primary/Secondary/Tertiary claim submission (via paper/fax/electronic)
  • Rejection Management
    • Online rejection checking (via Clearing House)
    • Correction and resubmission of the rejected claims (via Clearing House)
  • AR Follow-up & Denial Management
    • Follow-up on pending AR balance and working on denials
    • Follow-up on possible reconsideration requests
    • Filing reconsideration requests & appeals
  • Payment Posting
    • Patient payment posting and adjustments
    • Insurance payment posting and adjustments

Are You Looking for streamlined medical billing assistance?

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