- May 12, 2022
- Posted by: Steve Smith
- Categories: DME Billing, DME Billing Services
DME Billing – Not as Easy as it Sounds!
DME is among the fastest growing sectors in the health care industry today. As health care technology continues to advance by leaps and bounds, increasingly sophisticated and versatile equipment, intended for various kinds of therapeutic uses, keeps arriving. The range of medical devices or equipment covered under the entire DME (or Durable Medical Equipment, in case you’ve been wondering) gamut today is truly mind-boggling.
Is follows naturally from the above that DME billing is an area that is assuming rapidly increasing importance in the scheme of things. As DME products continue to proliferate, the intricacies and complexities of DME keep increasing. Whether you are billing for Medicare or any another commercial health plan, it is of utmost important that the biller understands the specific requirements for crafting that ‘perfect’ claim. Let’s take a close look.
The many shades of DME Billing
Billing for DME products, with the aim of getting reimbursed under the patient’s health plan, is the onus of the doctor who prescribed them in the first place. This is alright but what makes things a little more complex is the fact that DME billing requires not just submitting a simple claim to the insurance provider, but also providing supporting documents that help establish the ‘medical necessity’ of the prescribed devices. And in many cases, such equipment requires prior authorization which is a formal nod from the patient’s health plan that it will cover the cost of the DME eventually.
Another point to consider while billing and coding for Durable Medical Equipment is that they are often rented than purchased. Owing to their usual high cost and their often limited time of use, many patients opt for renting them rather than purchasing them outright. The codes and their modifiers used on the claim, change accordingly.
Staying ahead of Billing Challenges
It is easy to see that one of the most critical aspects of DME billing is staying aware of every updated rule and policy of every insurance payor out there. It is, on the whole, an area that demands specialized skill and knowledge. Unfortunately, many DME providers find these lacking in their in-house billing staff. It’s no wonder then that a growing number of such providers are opting for strategic outsourcing of their billing activities to professional, specialized billing experts. The outcome is an improved and streamlined revenue cycle, with increased collections and a reduced rate of denials or failures. It’s definitely an option worth exploring if you are serious about keeping all the usual perils of DME billing at bay.