DME Billing Services
Unmatched versatility amalgamated with complete proficiency in delivering actionable support as a DME billing services provider, Sunknowledge is a one-stop destination offering comprehensive RCM support at the best pricing standards in the marketplace among DME billing companies.
On a dedicated model of engagement, we offer our DME billing services on a stand-alone as well as end-to-end basis that enables you to pick & choose from our services or rather opt for an integrated approach. Our team has proficiency across all leading practice management/ billing systems used in the competitive landscape for billing services for DME vendors.
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 manufacturers 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.
#6 Things That Will Help You to Better Understand DME Billing, 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, 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.
DME categories with the most provider orders in 2023
The global market for durable medical equipment (DME) reached a valuation of USD 221.35 billion last year and is anticipated to maintain a steady growth trajectory with a compound annual growth rate (CAGR) of 5.90% from 2024 to 2030. A surge in chronic ailments, encompassing urological disorders, cancer, cardiovascular ailments, neurovascular diseases, and various other chronic conditions, is driving up hospital admissions significantly, thereby fueling the expansion of the durable medical equipment market worldwide. Adapting to evolving demographics and healthcare demands, here are a few DME products that are much in demand – Oxygen Devices and Accessories- 32.30%, Humidifier Equipment- 23.00%, Temporary Codes for Durable Medical Equipment Regional Carriers- 9.70%, Wheelchair Accessories- 4.40%, Walking Aids and Related Devices- 3.40%, Hospital Beds and Related Supplies- 2.30%, Wheelchairs and Mobility Devices- 2.00%, Other Lower Extremity Orthotics- 1.70%, Foot Inserts, Removable- 1.60%, Knee Orthotics- 1.30%, Ankle-foot Orthotics- 1.30%, Additions, Lower Extremity Orthotics- 1.20%, Wrist-hand Orthotics- 1.10%, Other Orthopedic Footwear- 0.90%, Infusion Supplies- 0.90%, Pneumatic Compressors and Related Equipment- 0.70%, Breast Pumps- 0.70%, etc. Sunknowledge for the last 15 + years has been doing an outstanding DME billing operation for all the above products as well and more.
We have the highest productivity in the whole DME RCM world
|DME – Productivity Estimation
|Eligibility Verification – online
|120 – 137 Patients
|Eligibility Verification – online (with same/similar check)
|95 – 110 Patients
|Eligibility Verification – calling (with same/similar check)
|40 – 45 Patients
|Eligibility Verification – calling (with same/similar check) BCBS
|20 to 25 patients
|25 New Request
|Prior Authorization (with dr.’s office follow/up) / Re-authorization
|20 – 22 New Request
|Dr.’s office follow-up
|32 – 48 Accounts
|Order entry (patient, provider, insurance, item etc.)
|55 – 60 Patients
|85 – 90 Orders
|125 – 150 claims
|Payment Posting – auto (without audit)
|Payment Posting – auto (with audit)
|Payment Posting – manual
|180 – 220 lines
|Accounts Receivables follow-up
|Accounts Receivables & Denial Management
|40 – 50 Claims
|CPAP Compliance (with patient counseling calls)
|30 – 32 Calls
|55 – 60 Contacts
|Re-supply order calls (to patient to confirm requirement)
|65 – 70 Contacts
|Hold (eligibility, authorization, insurance change, manual hold etc.)
|45 – 50 Accounts
Note: This takes into consideration time taken while working on Brightree
The Sunknowledge Advantage in DME Medical Billing Services
A 97% first pass collection rate which is one of the highest in the industry due to our stringent pre-billing DME billing services (eligibility, prior authorization, doctor’s office follow-up, order entry & confirmation), we eliminate any future issues with claims getting denied. Sunknowledge is an expert when it comes to order processing services!
KEY HIGHLIGHTS OF OUR DME BILLING SERVICES
- Follow-up on incomplete prescription with physician’s office
- Follow-up for document collection (diabetic verification forms, LMN, CMN etc.)
- Error free patient entry
- Error free sales order creation
- 100% HIPAA compliance
- Real time transaction audits
- Primary and secondary insurance verification
- Insurance verification for rental items
- Obtaining authorizations & extending authorization
- Open order audit and clean-up
- CPAP user compliance tracking and counseling calls to non-compliant patients
- Claims submission within 48 hours of receiving proof of delivery
- Rejection follow-up within 24 hours
- Tracking and follow-up of partial or incorrect payments
- Denial management based on detailed analysis
- Methodical and proactive AR follow-up
- Timely payment posting to reflect accurate AR
- Customized reporting
Our Robust Redundancy Plan in DME Billing Services will Help You Manage
- Shortage of staffs due to outbreak of any natural calamity
- Lack of staffs due to high rates of employment
- Resource migration for meeting project deadlines
Why Choose us As Your Reliable DME Medical Billing Destination
- Exceptional Productivity Standards
- No, Write-Offs Or Adjustment On Claims Without Your Consent
- Customized Reporting Meeting Your Specific Needs
- Only Medical Billing Company Excelling In Both Pre/Post Billing
- Our Rate Is As Low As $7/Hr
- 70% Instant reduction In Operational Cost
- Dedicated Account Manager Providing You End To End Support
- Working With 100’s Of DME Clients All Over USA And Can Provide Excellent References
- Liability Insurance Cover Of $1/3 Million From Geico/ Hiscox For Any Errors Of Omission & Commission
- 100% HIPAA Compliance
- No Binding Contract With 30 Days Exit Clause
WHY WOULD I WANT TO OUTSOURCE MY DME BILLING?
We offer unique support with all the heavy lifting work for both pre and post RCM requirements. Our versatility across all major & emerging practice management systems, ability to offer an expert team working @ $7 / hour, customized reporting makes us a champion DME billing company. We have reduced billing costs by 70% for the biggest & the best!
WHICH ARE THE ITEMS INCLUDED IN DME?
DME includes all but are not limited to only electric and manual wheelchairs, traction equipments, crutches, walkers, ventilators, nebulizers, hospital beds, ostomy supplies, lifts , pressure mattresses and many more.
WHICH ARE THE CODES USED IN DME?
The HCPCS codes used in Durable Medical Equipment ranges from E0100-E8002. Walking aids and attachments are included in E0100-E0159, Commode supplies and chairs are included under E0163-E0175 while E8000-E8002 categorize Pediatric gait trainers.
HOW DO I TRANSFER MY MEDICAL BILLING DATA TO YOU?
As far as transfer of data or information goes we offer world-class standards combining compliance with flexibility. You can scan and upload it on our server where it gets recorded. We can also retrieve/work remotely to have access to your current DME billing system. We believe in working as an extension of your existing operations!
WILL YOU BE ABLE TO HANDLE PHI INFORMATION SECURELY?
As a 360-degree revenue cycle management company, Sunknowledge takes pride in its robust standards of security. We adhere to 100% HIPAA compliance while dealing with your PHI. Also, we have ISO certified standards and use the process of encryption in our emailing system for any exchange of PHI information. We are currently working with excellence & trust for giants in the healthcare space!
DO YOU HAVE EXPERTISE IN THE SOFTWARE I USE?
We have expertise in working with all kinds of software in billing services for DME providers like Brightree, CPR+HME, OPIE, and many other prominent ones including emerging ones like NikoHealth, DMEWORKS, TeamDME, and others. Also, we are perfectly comfortable in working with any client proprietary platform and will get a complete understanding if you are using any during our period of transition at no additional costs!
DO YOU HANDLE UNPAID CLAIMS?
We have demonstrated capabilities in recovering aging accounts as old as 90 days or more. Our team of denial management/accounts receivable experts delivers actionable support in handling delinquent accounts. We believe to improve your rate of collections by 30% to 40% within the first month itself with our engagement as a DME billing company.
HOW SOON CAN WE START?
We can start immediately! We have a flexible approach with contractual delegations with a “no binding” system in place. Talk to our team to know more about how we work and what difference we bring to the table in DME billing services!
Get started today!
Hedge your bets on us as we ensure unparalleled consistency in DME billing services with our task specific pre/ post RCM activities! We help you improve your cash flow; eliminate process loopholes that make you lose money!
Know more about how we bring a difference! Schedule a “no commitment call” with our experts now!