- December 18, 2024
- Posted by: Josh Knoll
- Category: DME Billing
The Center for Medicare and Medicaid (CMS) has released an update on durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) for 2025, considering the Consumer Price Index for All Urban Consumers (CPI-U)[1] for the adjustments.
Based on the information by the American Association for Homecare[2] concerning such alterations the CPI-U will be raised from 2.4% to 3% in the calendar year of 2025. However, the inflation adjustments will vary depending on whether such equipment is included in the competitive bidding program (CBP) or whether the patient resides in a former competitive bidding area (CBA).
Based on these changes, the durable medical equipment (DME) providers are bowing down through the crises of perplexities.
DME billing is plagued with intricate claim submission requirements and the changes within the fee schedule will only increase this.
Key Adjustments and their Impact on DME Billing Services
For DME providers, looking ahead also means looking out for the next pitfall, or next reimbursement cut, unfounded denial or unnecessary complicated payer interactions. The upcoming changes in the fee schedule have increased the complications for the providers.
Here are the key adjustments due to the 2025 fee schedule in durable medical equipment-
- For Competitive Bidding Program (CBP) items in former Competitive Bidding Areas (CBAs), payments shall be raised by 2.9%.
- For DME items which were never part of the CBP, for instance urological and ostomy supplies, the 2.4% inflation adjustments will be the same irrespective of the location in the country.
- For CBP items in rural areas the 50-50 blended will be continued, where 50% is fully adjusted regional payment and 50% unadjusted fee schedule from 2015.
- The component of the reimbursement calculation that would be based where it would stick with the rates as in 2015 will remain constant and the fully adjusted part will rise by a tune of 3%.
Implication for Providers
You can anticipate there will be a slight increase in the reimbursements, though items and category will be varying.
Precise billing and alignment of claims with updated guidelines is essential to reflect these variations within the fee schedule, otherwise you will gain a risk of delayed reimbursements and denials.
Adjustment of reimbursements vary by state. For instance, where the blended rate is 50-50 in the rural areas, only the adjusted three percent will be affected. These nuances must be well understood to appropriately measure the market in relation to recurring revenue for the providers.
Well, the changes will lead to a modest reimbursement increase for the providers. However, with the increasing patient volume and workload complications within the DME billing processes will increase.
On top of these changes, HCPCS Level II code set which is used to report for DMEPOS will be updated[3] for FY 2025, including 169 new codes, 56 changed code descriptors, and 63 code deletions. These changes will be taking effect from January 1, 2025.
Of course, this will add another layer of complication within DME billing services and revenue cycle management.
So, what’s the solution?
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Irrespective of the size of your practice, our team of experts can handle all the intricacies of insurance claims, documentations and payers while making every effort to get you the most out of your reimbursement with least effort. As obvious as this may seem, if your practice operations are struggling with DME billing, we are just a call away!
Ref Link:
[1] https://www.bls.gov/news.release/pdf/cpi.pdf
[2] https://www.vgm.com/services/government-relations/dmepos-cpiu-adjustments-for-2025-/
[3] https://www.aapc.com/blog/91755-code-changes-for-dmepos-require-action/?srsltid=AfmBOoqeGntA0M9VRPw67lbu2H9tlr0ITAw8Fp2THnno0_g84Ex7sn8D