- June 24, 2022
- Posted by: David Smith
- Category: DME Billing
The Long Winding Road of DME Billing
Medical billing is a complex subject, especially when it involves seeking compensation from insurance companies for services rendered to patients by health care providers. It certainly goes a long way beyond issuing a simple invoice and expecting to get paid by the patient’s Health Plan. When it comes to DME billing, things tend to turn a little more complex, to say the least. There are a number of steps involved, all of them critical for ensuring that a submitted claim finally gets paid. Let’s take a quick look at some of the more important ones.
Capturing the patient’s data, verifying his plan details and checking his eligibility constitute the important initial steps. Seeking prior authorization for a prescribed device is another very important task to complete. Without this formal nod of approval from the insurer, no claim for reimbursement will be entertained afterwards. Next comes preparing the actual bill which should be accurately coded with the relevant HCPCS-II codes along with all applicable modifiers, and must also be supported by documents that are required by the Health Plan to process the payment. The tail phase involves submitting the claim, working closely with the payer to resolve denials (if any) and regularly following up on the status of the payment.
Issues that slow Down the Billing Process
Every busy DME practice needs a steady flow of revenue. Faulty billing only causes to slow it down. DME billing done badly can actually hurt collections as such bills are rejected outright by insurance companies. So what are the areas of billing where billers are prone to err more? Well, without doubt, it is the part where coding for the services is involved. The major villains here are using the wrong codes, under-coding and over-coding. The provider should ensure that every piece of equipment, along with its accessories, should be billed for and accurately coded.
Another factor that can slow down the entire process to a great extent is not initiating the prior authorization process early. Obtaining prior authorization for a prescribed device can be a tedious process and only a proactive approach to the task can help to get it done in the shortest possible time.
With so many factors that can slow down the billing process, it is no wonder that a large number of DME practices, especially the more busy ones, choose to outsource all their DME billing tasks to specialized, third-party billing agencies. It not only helps to take the burden off the provider’s in-house billing staff, but actually saves operational cost to a great extent. Further, by engaging a professional billing partner, providers can enjoy a more streamlined billing process and ultimately, more collections in less time.