What is DME?

Durable Medical Equipment (DME) is a therapeutic item that is prescribed by the physicians to patients that are suffering from a certain medical condition. Beyond reasonable medical needs or necessity, a provider cannot offer these items before following a comprehensive DME billing services process.

CPAP, Nebulizers, kidney machines can be some of the examples of Durable Medical Equipment. A major chunk of Durable Medical Equipment is usually aimed at extending therapeutics relief for patients with a long term critical condition. Items under DME are durable for an extended period of operations. Hence, billing services for DME suppliers require specialized intervention.

What is DME billing?

After the invoice is coded, it is important to collate all the documents and continue the process of claims submission in DME billing services. Missing documents or not having prior knowledge of payer requirements can be the reasons for higher rates of denial. Clean claims can reduce denials, days in A/R, and guarantee improved cash flow. Outsource DME billing services is the process of effectively managing the front and back end activities needed to submit and get paid for a claim from the insurance with a reliable vendor.

What is DME coding?

Medical coding is a specialized segment and coders who work will know all the directory of codes that are used under the DME services. It translates the procedure involved and is helpful for providers and distributors track the billing for fast-tracking the claim in billing services for DME prescribers. An example of the HCPCS code for CPAP is E0601.

What sets DME billing different from standard medical billing procedures?

What sets DME billing apart from other forms of medical billing is its unique structure, characterized by two primary components. Firstly, it accommodates rentals, offering flexibility in billing arrangements. Secondly, DME billing mandates the use of HCPCS(Healthcare Common Procedure Coding System) codes for accurate claim submissions. These codes play a crucial role in identifying the specific item or service billed. For example, the HCPCS code E0607 signifies a home blood glucose monitor, facilitating precise documentation and reimbursement processes.

Six Things That Will Help You to Understand DME Billing Better, Breaking Down the Components 

1) How to bill for DME 

Establishing a streamlined and comprehensive billing process from initial intake to claims submission is paramount. A well-structured billing procedure not only enhances efficiency but also maximizes reimbursement potential. 

Billing for Durable Medical Equipment in fact is quite a crucial process. Whether you’re a Medicare supplier, practitioner, or healthcare administrator, it’s important to ensure accurate ordering and documentation for DME claims.  

Here’s how to bill for DME under Medicare: 

• Complete the CMS-1500 form using the Common Electronic Data Interchange (CEDI) Claims Portal, which Medicare contracts for electronic claims submission.
• Your Medicare Administrative Contractor (MAC) will review and process your claim to determine its compliance with medical necessity guidelines.
• If the claim is approved, Medicare Part B will cover 80% of the costs, and the patient will be responsible for the remaining 20%.
• In case of claim denial, follow the MAC’s instructions for resubmission after addressing any issues identified during the initial review.

2) What are the Guidelines for DME BILLING? 

Staying abreast of billing guidelines is paramount.  DME billing guidelines are subject to frequent changes across different product lines. Keeping pace with these evolving regulations is essential to ensure compliance and avoid claim denials. Regularly consulting reputable sources like the CMS website can help you stay informed about Medicare and Medicaid DME guidelines. 

3) What DME Isn’t Covered by Medicare?

Medicare’s coverage of Durable Medical Equipment(DME) is dependent upon its determination of medical necessity. If the equipment is deemed non-medical or inappropriate for home use, Medicare will deny the claim. Here are examples of DME items not covered by Medicare: 

• Convenience Items: Items such as raised toilet seats or spare tanks of oxygen fall under this category.
• Educational Materials: Braille teaching texts are considered non-covered items.
• Not Suitable for Home Use: Equipment like oscillating beds may be denied if they are not deemed appropriate for home settings.
• Non-reusable Supplies: Catheters, irrigation kits, disposable bed sheets, and similar items that are not for rental purposes are typically not covered.
• Not Medically Necessary: Items like white canes for blind individuals, which are not essential for mobility, or grab bars, telephone alert systems, and similar items may be denied if they are not considered medically necessary.

4) Who is a DME billing specialist?

DME billing specialists play a critical role in ensuring the accuracy and completeness of submitted claims. Starting from data capturing to verifying compliance with payor guidelines to rectifying HCPCS codes, a DME billing specialist expertise in  minimizing the risk of errors in the DME billing process, and claim rejections while facilitating a smoother billing process. 

5) Understanding DME billing services 

It is no secret that today outsourcing DME billing services offers access to specialized expertise which can alleviate the burden of time-consuming billing tasks. By entrusting billing responsibilities to experienced professionals, you can redirect resources towards core business functions such as marketing and client acquisition. However, it’s crucial to conduct thorough research and select a reputable billing company tailored to your specific needs. 

6) All about DME billing companies

Partnering with trusted DME billing companies can bring significant changes faster and efficiently. Collaborating with a reliable DME billing company can streamline operations and enhance revenue management. Look beyond mere claims submission services and seek out partners like Sunknowledge, who offer comprehensive solutions ranging from account receivable management to audit support. By choosing a reputable billing partner, you can ensure timely payments and minimize the incidence of claim rejections. 

Fight decreased collections and billing errors with our DME billing services

The DME billing industry is an evolving field, not being any steps behind the changes in DME’s regulatory compliance. And keeping up with this can be quite challenging, one of the primary reasons why many DME suppliers are now seeking to outsource DME billing solutions. Some of the challenges include decreasing collections, errors in billing frequently, the cost of training new staff, and the impact of operational disruption due to current staffing shortages. So, today most DME providers and looking to outsource when billing for DME. 

Left untreated, these issues may lead to reduced productivity and thus revenue loss. By outsourcing your DME billing to us, you can focus more on your core competencies while letting us handle the complexity of the billing jobs. Our dedicated team works tirelessly to increase revenue DME and improve cash flow and thus helps your practice prosper even under the most competitive environment.

Understanding the Importance of DME Billing Professional Partner:  

Today the durable medical equipment (DME) is an important aspect of the healthcare system. It ensures effective working and easy access to such equipment. Some of the prominent reasons that indicate its importance are as follows: 

Faster financial reimbursement: DME billing helps providers get proper and faster reimbursement for the expenses of durable medical equipment available for patients. 

Reimbursement control: With precise DME billing, the professional expert assists in maintaining health regulatory and standards compliance and thus avoids legal violations, especially relating to the requirements on billing and coding practices. 

Proper documentation and audit: Ensures proper billing generation of a complete document and audit trail to promote transparency, accountability, and proper communication among healthcare stakeholders. 

Rapid claims processing: Working on accurate billing the expert reduces denial risk, accelerates claims processing, and reduces administrative burdens on healthcare organizations. 

Stress-free access to medical equipment for patients: With years of experience and expertise, they offer reliable procedures for billing and enable the provision of durable medical equipment when needed; so patients gain easier access to the appropriate tools they need to maintain or improve their health status. 

Efficient Revenue Cycle Management: DME billing experts also play an important role in the revenue cycle of healthcare organizations, especially considering the cash flow, financial viability, and overall operational efficiency of organizations. 

Streamline Your DME Billing Services and Improve Revenue and Accuracy by Our DME Billing Experts 

Today the durable medical equipment billing industry is undergoing perennial renovation, thanks to the ever-changing regulatory compliance landscape. Staying current with the shifting DME billing landscape is a significant challenge, which is why outsourcing durable medical equipment billing services are the go-to thought for most DME companies. Shrinking collections, billing errors, cost of training new hires for billing functions, and suspended operations in the absence of staff are many concerns faced by medical equipment providers. 

If neglected, all existing problems can lead to slow productivity and revenue. If you are troubled by these challenges, outsourcing DME billing services to us is the safest choice to stay focused on your core competencies. We work round-the-clock to bring you higher reimbursements and better cash flow.

Durable Medical Equipment (DME) billing is the process of submitting and receiving reimbursements or payments for the claims related to medical devices and supplies that are prescribed for supporting individuals for the betterment of their daily lives. DME billing space is a critical arena of medical revenue cycle management that involves numerous key considerations, including

• Documentation
  Claims require detailed documentation that accurately reflects the medical necessity for the equipment.
• Coding
  Along with ICD-10 and CPT, you must consider HCPCS level II codes to maintain accuracy throughout the DME billing.
• Compliance
  The changing regulatory compliance is a tough spot to cope with, but you must adhere to that to avoid any adverse legal or financial consequences.
• Collaboration
  DME billing demands collaboration and coordination among stakeholders like- medical professionals, suppliers, and payers.
• Denials
  Claim denials in DME billing are common due to several reasons like missing or incorrect information, insufficient documentation, lack of proof of medical necessity, and so on.
• Outsourcing
  To streamline the DME billing processes several providers outsource their DME revenue cycle management to medical billing and coding companies specialized in the DME niche.

We have the highest productivity in the whole DME RCM world

Note: This takes into consideration time taken while working on Brightree