Durable medical equipment, or DME, ensures a patient’s swift recovery and well-being. DME suppliers/ DME providers deliver, maintain, and repair medical devices – wheelchairs, CPAP machines, hospital beds, etc. It’s their basic task for which they are trained; however, billing tasks often break their back. Erroneous DME billing practices cost a significant portion of suppliers every year. On top of that, ever-changing healthcare regulations and payer policies in the US add another layer of billing complexity.

Now, DME billing isn’t just complicated; rather, it can feel downright unreasonable at times. We have seen in many DME supply houses that operational staff usually spend more time chasing signatures and correcting HCPCS codes than actually seeing patients. It’s the daily grind for thousands of doctors, supply managers, and DME billing teams across the country.

DME is supposed to assist patients in retaining their daily activities and living independently. While the practical scene looks like, billing staff are in a long-haul fight with payers to secure prior authorization and reimbursement. Patients are getting frustrated due to a longer wait time to receive their devices. In many cases, patients even abandon their DME purchase or rental plans due to billing complexities.

Related Reading: DME Billing Company | $7/hr per FTE

Why the DME Billing Maze Exists

Here, we need to understand that DME billing isn’t broken by accident. It’s complex because payers (especially Medicare) want guardrails to prevent fraud and overutilization. In theory, it seems simple and straightforward; however, in practice, it adds a significant level of complexity. Such as –

Intricate Documentation

Clean DME claims involve stacks of documentation. DME suppliers must provide each and every piece of documentation that thoroughly justifies medical necessity and prescribed devices. They must attach progress notes, prior authorizations, and certificates of medical necessity without fail. Even if they miss submitting one paper, the payer will deny the claim.

Coding Complexities

HCPCS coding isn’t intuitive; rather, it requires thorough precision. DME coding staff must have an in-depth knowledge of HCPCS Level II codes, as these codes cover medical devices. Moreover, DME suppliers must align the codes with medical necessity, payer policies, and documentation requirements. It will ensure proper reimbursement and compliance. In addition to that, DME billing staff must stay up-to-date regarding the latest coding and modifiers amendments.

Ever-changing Regulation and Payer Policies

Healthcare regulation in the US experiences constant changes. Regulatory authorities set up new rules every now and then. On top of that, insurers come up with new policies pretty frequently. Keeping up with Local Coverage Determinations feels like a full-time job. Hence, staying up-to-date is not an option; rather, it’s a mandate.

Inefficient Denial Management

Payer denials drain a notable amount of revenue from DME suppliers. The latest industry data, published by the CMS, shows that about 21.41% of DME claims faced improper payment rates. It cost about $1.92 billion in revenue for DME suppliers. Eradicating payer denials or establishing a streamlined appeals process is the only way to keep DME suppliers’ finances strong.

Hence, from the above discussion, we can understand that DME billing complexities notably increase paperwork hassles and affect cash flow, as well. In addition, erroneous billing usually results in payer denials and delays. Also, it exposes the suppliers to audits and penalties. While dealing with these billing complexities, DME supply staff often get distracted from their primary task, i.e., supplying equipment on time.

Top 7 Proven Ways to Simplify DME Billing

Now, every DME supply house wants to know the practical solutions to deal with billing complexities. To ease their effort, we have listed result-driven DME billing strategies for success below.

1. Train, Train, Train

General medical billing knowledge is not always applicable to DME claims. Staff need specialized training on HCPCS coding, LCD updates, and payer-specific rules. DME suppliers should conduct quarterly training on the latest regulations and payer policies. It will keep their denial rates notably low.

2. Standardize the Paper Trail

As mentioned above, DME claims involve detailed paperwork. Billers should submit all-inclusive documents that justify the claim. Payers thoroughly scrutinize every piece of paper. They validate that the supplied equipment was medically necessary and billed accurately. To streamline the process, suppliers must set up standardized documentation guidelines.

3. Let Technology Carry Some Weight

Modern billing software isn’t just about speed. Integrated with EHRs, it can auto-populate fields and flag missing info. Some DME software like DME Works even predict claim outcomes. Some tools use AI to scan for missing information before submission. This effort significantly increases first-pass approval rates of DME suppliers and ensures seamless cash flow.

4. Conduct Internal Audits Quarterly

DME suppliers should not wait for payers to tell them what’s wrong. Here, DME billing staff members should conduct monthly or quarterly audit to catch any mistakes related to coding, documentation, etc. This helps in faster claims before submission. Moreover, they must ensure a thorough compliance to healthcare regulation and payer policies. This effort will save the claims and ensure maximum reimbursement right on time.

5. Talk with Patients Early

Patients should have a thorough knowledge of the price or rent of their DME and how much they may have to pay for it. As we have seen, a lot of billing disputes start with patient confusion. Clear upfront conversations about coverage and out-of-pocket expectations will make the patients and their families mentally prepare for the tentative expenses.

6. Track Metrics like a Business

Data shows a comprehensive picture of how a DME supply house is performing. DME billing staff members should closely watch the metrics below to streamline their internal operations. That includes –

• Denial rates
• Days in AR
• Reimbursement turnaround

These numbers tell the story of the billing efficiency of DME suppliers. In addition to that, these data enable billing experts to spot bottlenecks. This way, suppliers can fix unwanted billing errors before they become significant and affect revenue.

7. Call in Outsourced DME Billing Specialists

Many suppliers consider outsourcing DME billing like giving up administrative responsibilities. They presume that, by employing a third-party DME billing company, they will lose control of their internal operations. However, it’s not the truth; rather, for many practices, outsourcing offers welcome relief.

Specialized billing firms know the quirks of different payers and handle claims with fewer errors. For smaller clinics, this move can be the difference between steady revenue and constant cash flow panic.

Related Reading: Navigating DME Billing Regulations and Compliance

How SunKnowledge Streamlines DME Billing Complexities

For over 17 years, SunKnowledge Inc. has been performing DME billing and end-to-end RCM with extreme precision. Our top-notch billing specialists know every billing requirement and fulfill the same without any mistakes. Hence, with our assistance, DME suppliers not only enjoy swift reimbursement but also stay on the safe side of healthcare regulations. We ensure the following to ease DME suppliers’ billing efforts:

• Our optimum DME billing accuracy makes us one of the top performers in this field.
• We ensure an over 97% first-pass acceptance rate in DME billing that secures seamless cash flow for suppliers.
• Our most affordable pricing, only $7 per hour, helps DME suppliers reduce about 80% of administrative expenses.

Above all, when we address DME billing complexities, the internal staff of the supply house can enhance their stocks and service margin. So, if you are also struggling due to increased denials and piled-up AR, contact us for effective billing and RCM solutions.