Surviving the DME Billing Mayhem

Looking DME Billing In The Eye

If you are involved in the business of prescribing or providing Durable Medical Equipment (or DME, as they are usually referred to in short) to patients who needs them for various therapeutic reasons, you can’t afford to shy away from DME billing. The term essentially means billing for DME items so that their cost may get eventually reimbursed under the patient’s health plan. So far, so good. But in reality, matters tend to get a bit tricky because getting the cost reimbursed is seldom a simple path.

Having said that, it remains critical that DME billing is done with all the utmost sincerity, because the revenue from a DME business depends largely upon it. You may like it, or hate it, or even fear it – but you need to face it squarely. Here are a few tips to help you shed your inhibitions and take DME billing by its horns.

Understanding the many Challenges of DME billing

One of the biggest impediments in DME billing is what is known as prior authorization. In other words, establishing the medical necessity of a piece of DME and obtaining the required authorization from the concerned Payer, can spell nightmare for many Providers. When it comes to DME, many a time, prior auth requests are turned down. This can lead to tedious follow-ups till the required authorization is secured, resulting in a waste of valuable time that could have been better spent on actual patient care.

In view of such frequent problems with DME billing, a large number of practices opt for dedicated third-party billing services that help them reduce denials, increase collections, have a more efficient billing process and stay in better control of their entire revenue cycle. Some of the best ones among these billing service providers work on an hourly rate, or simply charge you a fixed, pre-agreed percentage of the total collections they are able to generate. The latter is a win-win situation where the billing company earns in direct proportion to the claims they are able to clear.

Another benefit of an outsourced billing service is the amount of savings it brings in operational costs, not to mention the instant reduction of all the usual hassles and demands of maintaining a separate billing staff. It also eliminates the need for spending on expensive billing software as third-party billers take care of such requirements and directly post the payment to the Provider’s system.