- November 16, 2022
- Posted by: Steve Smith
- Category: DME Billing
Taking a Critical Look at DME Billing
In a broad consideration of the different types of medical billing that one encounters in today’s world, DME billing apparently come across as more complex than most others. This is chiefly due to the fact that DME billing needs to take into account whether a specific DME item or supply has been purchased or rented. Based on the nature of procurement, billing for a specific DME item can attract different codes and different amounts of reimbursement.
Another challenge in DME billing is clearly establishing the medical necessity of an item. Insurance companies need to be fully convinced that a particular piece of equipment or supply is absolutely necessary to bring a distinct therapeutic benefit to the patient, is one that cannot be replaced by a cheaper or different variant, and is meant to be used for a certain stretch of time. Only after the provider is able to convince the payer on these grounds that the prospect of obtaining coverage for it under the patient’s Health Plan, and getting reimbursed eventually, can arise.
All such complex demands of DME billing make it something that is best handled by dedicated experts. Unless a biller is well-acquainted with the various caveats of reimbursement, or be proficient in HCPCS coding, or be persistent and proactive in securing prior authorization for a prescribed device, the threat of a claim for a DME item getting denied looms large.
Ensuring Improved Efficiency and a Better Outcome
In the face of such challenges, a growing number of DME providers are choosing to outsource their DME billing tasks to specialized, external billing service providers. One of the biggest advantages of such a strategy is that it lets providers get instant access to a ready pool of skilled DME billers without having to go through the conventional rigmarole of finding the right personnel, hiring them, arranging for the overhead and providing all the statutory employee benefits, and ensuring all the other essential aspects of maintaining a regular in-house staff.
Other benefits include an instant improvement in the overall efficiency of the DME billing process. With a professional billing partner, providers start enjoying a higher rate of collection, a lowered rate of denial and fast, accurate formulation and submission of claims. And when take into account the highly competitive rates at which such third-party services are available nowadays, providers stand to gain substantially as it drastically reduces operational cost and administrative hassles in the long run.