- March 11, 2022
- Posted by: Josh Knoll
- Category: HME Billing
Speaking generally of medical equipment that is used by patients with specific conditions, home medical equipment (or HME, in short) can be easily said to constitute a large part of the entire corpus. Ranging from simple accessories to complicated devices, home medical equipment are designed to be used at home by people with certain conditions. A close kin of HME is DME, or durable medical equipment, which, in essence, is the same as HME. The two terms are often used interchangeably.
When HME is prescribed for a patient, billing for the same can get a bit tricky sometimes. Even though most insurance processes cover a range of such equipment, establishing the medical necessity for prescribing/using them is critical in order to be paid. Moreover, not every piece of medical equipment or supply can be categorized as HME. Broadly speaking, in order to be considered as belonging to the HME category by insurance companies, the equipment or supply needs to meet the following criteria:
a. It should serve a distinct medical purpose
b. It should be used repeatedly
c. It should last for 3 years or more
More often than not, HME billing fails to keep these in mind. As such, claims submitted to payors get rejected or denied summarily. It may be pertinent to mention in this context that prior authorization, which is basically a formal process of ensuring that a particular HME will be covered under an insurance plan, can act as an important means for eliminating unpleasant surprises later.
So, what are some typical examples of HME that insurance plans cover? The actual list is a long one but some of the common ones are
♦ Oxygen tanks
♦ Blood glucose meters
♦ Hearing aids
♦ Contact lenses
♦ Infusion pumps
♦ CPAP machines and supplies
♦ Apnea monitors
♦ Prosthetic devices, and so on
When you are considering engaging an HME billing partner, the list above can serve as a good starting point to help you understand the extent and capabilities of the billing service provider. Home medical billing is a large field, demanding deep familiarity with the various codes associated with specific devices and supplies. Having prior experience in billing for the kinds of equipment listed above can surely help to generate a better rate of success. In this regard, it may be said that choosing a reputed and well-established HME billing agency with a sufficiently long experience can yield better results in the long run.