- June 9, 2020
- Posted by: Thomas Anderson
- Categories: DME Billing, HME Billing
In the HME and DME billing, people often tend to get confused if the particular item can be considered as a Home Medical Equipments (HME) or Durable Medical Equipment (DME) item. As its only a thin line that distinguishes both domains.
Since there are many items that are described and considered as a DME product and can also be categorized under the category of the HME billing too. This is because many items in the DME billing are essentially a home medical equipment service they are being used as providing home-based medical equipment services, which are never considered as one-dimensional.
What is Durable Medical Equipment (DME) billing?
Items that are essential for supporting a therapeutic or medical need of a patient that a licensed physician prescribes due to specific illness or medical conditions of the patients helping them live a better life, these items are considered as the Durable Medical Equipment; which are:
- Special hospital beds
- Special commodes for patients
- Ambulatory aids
- Oxygen tanks
- Crutch etc
In fact, the DME items when prescribed by physicians, most of the health insurance companies including Medicare term these as DME benefits.
DME billing– a DME billing process starts with data entry, eligibility, authorization process which is further accompanied by doctor office follow-up, confirmation, claims Submission. It further continues with the process like rejection management, payment posting, and finally denial management.
In fact, with all these procedures, as some of the durable equipment billing companies insist on making sure if the equipment has been set-up by the trained people properly they ensure a home evaluation in order to be certain that the necessary safety requirements are met in the particular home for the durable them.
Also, these companies even insist on going through every detail of usage, operation and even on maintenance. Giving clear instructions to users about the process of monitoring and report changes in the medical conditions of the patients, these companies take initiatives in checking if there is insurance coverage for a particular piece of DME.
However, the DME billing services providers in case of reimbursement when challenged by the insurance carriers should also help the patients in resolving the issues. In fact, retrieving the DME items from the patients’ homes is also considered as a part of DME services, if the item doesn’t meet its requirement.
What is Home Medical Equipment (HME) billing?
It is the same as DME but the only difference is that the HME items are mainly and only being managed from a home or any other private facility whereas DME can be managed outside the home facility too.
HME billing – today due to the technological advancements changing the entire HME billing prospective, highly trained clinicians holding multidisciplinary backgrounds like nurses, pharmacists, etc are employed by most HME service providers. This used to lack two to three decades ago, where HME services were rendered by delivery technicians and respiratory therapists. In fact, today most of the healthcare providers think outsourcing their HME billing is the best alternative today.
Though the process of HME billing process is the same as DME billing starting with data entry, eligibility, and authorization process continued with doctor’s office follow-up, confirmation, claims Submission, rejection management, payment posting, and finally denial management. The home medical equipment billing companies’ task is to ensure proper instructions on the item about their operation and maintenance should be given. Ensuring that 24/7 service was made accessible to the patients at their homes; the HME billing companies also ensure proper FDA licensure for HME meeting the requirement.
With all these HME and DME billing requirements, a proper billing operational extension today is very effective and essential; as it not only helps in operational cost reduction but also ensures a seamless billing process along with efficient revenue generation.