How is DME Billing Different from Other Medical Billing?

What is DME billing?

Durable Medical Equipment, or DME in short, constitute one of the major aspects of modern healthcare. To attempt a simple definition, DME essentially refer to specialized devices or equipment, created to provide distinct therapeutic benefits. They have become a common sight across homes and healthcare facilities everywhere, and get prescribed in large numbers every day by medical practitioners to people of all ages. When a healthcare provider prescribes such a piece of equipment, a formal request needs to be sent to the patient’s health plan asking for applicable reimbursement. This process is known as DME billing. One ought to understand in this context that such a ‘request’, or ‘claim’, as it is more rightly called, is quite a complex process. Let’s take a closer look at how billing works.

How Billing works

Durable Medical Equipment are extremely varied in nature and they are usually expensive. As such, they are often rented instead of being purchased. The DME billing process varies accordingly, especially in the medical codes that are used on the claim.

It also needs to be borne in mind that medical billing, unlike other common forms of treatment such as prescription medication, infusion or surgery, strictly requires every claim to be accompanied by documents and declarations that establish the absolute necessity for use of the device or equipment. In other words, the payor needs to be completely satisfied about the fact that the prescribed DME is truly and absolutely necessary for the patient to treat (or provide assistance in) his or her condition.

Finally, every claim submitted to the payor needs to be diligently followed up by the provider to ensure that it is processed quickly and the payment is received. This, of course, also implies that the claim is submitted within the desired timeframe, all necessary documentation (as demanded by the payor) has been provided, all coding has been done thoroughly and accurately, and all denials or rejections, if any, have been addressed.

Increasing Efficiency in DME billing

Healthcare practices often find it too challenging or demanding to keep up with the myriad norms and requirements of different payors. Performing tasks typical to DME billing, such as verifying the patient’s eligibility, obtaining prior authorization, putting in all the required HCPCS Level II codes and following up on the status of submitted claims, takes a large chunk out of the time and budget allocated to such internal or back-office processes. This is the biggest reason why many providers opt for outsourced DME billing services, many of which are located off-shore and provide excellent support with very distinct benefits in cost, time and productivity.

It may be concluded by saying that outsourcing DME billing services to an experienced and capable billing agency can help to bring down operational costs, improve efficiency, reduce denials and ultimately lead to higher collections – benefits that no busy DME provider can really ignore.