What are The DME Billing Requirements

Any item that provides therapeutic benefits to a member due to certain medical conditions is known as a DME. It can withstand repeated use and is primarily as well as customarily to serve a purpose medically appropriate to be used at home.

What are Capped Rental payments in DME Billing

Capped rental payments include all the related costs of the use of the equipment by the member. It includes equipment, supplies, accessories, delivery & shipping, handling & setups, labor, visits & patient education , maintenance, repairs as well as the replacement of DME part in question!

To be eligible for reimbursements, a supplier of DME items & services must meet eligibility and even the credentialing requirements as defined by the BCBSNC. When it is eligible for coverage, it comes under the benefits provision of the patients.

General DME billing requirements
♦ DME needs a prescription to purchase or rent before it is applicable for coverage
♦ Certain items must be rented and may not be purchased
♦ Bill on a CMS – 1500 claim form
♦ Billing the applicable modifier after all the HCPCS code.
♦ Each claim will be having miscellaneous code and custom items like foot orthotics, specialty wheel chairs etc. which must include additional documents.
♦ Bill the maintenance and repair modifier codes first after the codes of procedure
♦ Submitting the complete description of the item
♦ Submitting factory invoice with the initial claim
♦ Certificate of medical necessity as applicable

A dedicated team in DME Billing: Is that a great idea?

To secure reimbursements, you need to rely on special experience. Finding a reliable team that has the proficiency in delivering stand out assistance, understanding the claims adjudication mandates should be the objective.

There are a lot of companies offering services in DME billing. However, finding someone who does better with client engagement, offers a full service destination will be a great help. If you find someone who will be taking care of all your heavy lifting work with pre billing efforts, that will be great.

There is so much to do with checking eligibilities, getting the prior auths on time, entering patient details , creating the sales order, collection documents from the prescribing physician. Till the delivery, you need to put a lot of things in order with this so that you can get you money on time. Finding some one that transforms your cash flow by extending a support reducing your operational costs by almost 70%, well that must be great for your business fortunes.

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