DME Billing Services
Unmatched versatility amalgamated with complete proficiency in delivering actionable support as a DME billing provider, Sunknowledge is a one-stop destination offering comprehensive RCM support at the best pricing standards in the marketplace.
On a dedicated model of engagement, we offer our 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.
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 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.
What is DME billing?
After the invoice is coded, it is important to collate all the documents and continue the process of claims submission. 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. DME billing is the process of effectively managing the front and back end activities needed to submit and get paid for a claim from the insurance.
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. An example of the HCPCS code for CPAP is E0601.
How is DME billing different from billing for other specialties?
There are two components of DME billing, it allows for the rentals and also requires the HCPCS codes. While submitting the claims, the correct codes help to identify the service provided or the billed item. For instance, a blood glucose monitor is represented by HCPCS code E0607.
3 Things That Will Decode Your World of DME Billing
# How to bill for DME?
You need to create as well as maintain an extensive system which is automated right from intake to claim submission. A streamlined DME billing process has a positive impact on the DSO ratio, improves provider patient relationships and helps the providers to gain maximum reimbursement.
# What are the guidelines in DME?
Payer policies with DME continue to change every time. DME billing falls under Medicare Part B and the CMS continues to make benefit category determinations and payment determinations for the DME items and services.
# Who is a DME billing specialist?
The goal of a DME billing specialist is to ensure that all claims submitted are accurate with information. All the needed paperwork is in place for reducing the number of claims that get rejected. They also have several other responsibilities like correcting the HCPCS codes, and ensuring payer compliance guidelines and claims follow-up.
We have the highest productivity in the whole DME RCM world
| DME – Productivity Estimation | Productivity (daily) |
| 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 |
| Prior Authorization | 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 |
| Order Confirmation | 85 – 90 Orders |
| Rejection management | 125 – 150 claims |
| Payment Posting – auto (without audit) | 800+ lines |
| Payment Posting – auto (with audit) | 500+ lines |
| Payment Posting – manual | 180 – 220 lines |
| Accounts Receivables follow-up | 70 Claims |
| Accounts Receivables & Denial Management | 40 – 50 Claims |
| CPAP Compliance (with patient counseling calls) | 30 – 32 Calls |
| Patient collections | 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 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
FAQ’s
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 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 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.
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!
Get started today!
Hedge your bets on us as we ensure unparalleled consistency in DME Medical billing 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!