All about DME Billing Services
Due
to the regulatory compliances, the DME has been undergoing perennial
renovations. As a result, it can prove to be a challenge for you to keep
updated with the constantly changing DME
billing landscape. Did you know? The DME consists of 2% of the annual
expenditure for Medicare. That's why claim denials are one of the most
challenging causes for healthcare professionals when it comes to billing
Durable Medical Equipment. This means that not all DME billing claims offer revenue reimbursements.
Though
the reasons and causes may vary, there is one similarity that they indicate a
major change in the revenue cycle for a healthcare provider. Therefore, DME
billing services
should be taken care of with a lot of precision and accuracy, as even a slight
mistake can lead to slow productivity and loss of revenue.
What is DME Billing
and Coding?
Durable
Medical Equipment refers to the therapeutic equipment prescribed to patients
suffering from certain adverse medical conditions. Nowadays, DME billing companies, coding
specialists, and data analysts use a customized DME coding system. It is more like
a DME directory for healthcare services. In fact, it acts as a bible for the
distributors and the vendors for handling and tracking the DME billing services so that claims don’t get missed. However, you should
also know that the DME coding system can never be an alternative to the HCPCS
releases.
DME Billing and
Insurance Coverage Indications:
When
a patient has the DME benefits and equipment suggested for him by the
healthcare professionals to treat a long-term illness, it gets covered in the DME billing services. Otherwise, the
equipment is not included in the patient benefit plan.
1. For the purpose of DME billing, the DME should not be
disposable or consumable unless it is essential for the effective use of the
same.
2. In the absence of any disability or
illness, a patient cannot use the DME.
3. The DME must be ordered by a
healthcare professional for use in the home setting for an outpatient.
4. DME must only be used for medical
purposes.
DME Billing Coverage
Limitations and Exclusions:
·
When
a patient uses one or more DME to meet his disease need, the coverage benefit
is only applicable for a single DME with the minimum specifications for the
requirements of the patients. They must include:
1. Standard power wheelchair vs.
custom wheelchair.
2. Standard bed vs. the semi-electric
bed or the floating bed or complete electric bed.
·
This
is a limitation that intends to eliminate the coverage for the deluxe DME or
the additional components of the equipment. It is not necessary to meet the
minimum specifications of the patient for the treatment of a chronic illness.
·
If
a patient rents or buys a DME that exceeds the guidelines mentioned above, he
is also responsible for the cost difference of the devices purchased or rented.
The
DME billing services exclude certain
coverage that includes:
·
Accessories
that are included in the DME services and are meant for the comfort of the
patient. These devices will not be covered by insurance companies:
1.
Air
filters
2.
Air
conditioners
3.
Batteries
for the nonmedical devices
4.
Humidifiers
5.
Nonmedical
devices for mobility
6.
Remodeling
or modification of the DME devices for home or vehicle to accommodate the DME.
Covered DME billing
services:
DME billing services include the various pharma
products or supplies to determine that:
1. DME is provided for preventing or
evaluating, diagnosing, or treating a chronic disease or injury, mental illness,
or addictive disorder.
2. DME is a medical necessity.
3. Anything that is not excluded from
the covered services.
3 Helpful Tips to
Follow for Billing Guidelines
DME billing needs accurate coding that ensures
correct claims submission, mainly when any updates occur. Here are three tips
that can help you in creating an efficient billing process so that you are
ready even when guidelines change:
#1 Provide Correct
Documentation
Accurate
claims submission requires proper documentation with precise coding. This also
includes verifying with the insurance companies whether specific documentation is
required before submitting a claim. This, in return, will prevent claim denials
in case an insurance company updates its policies.
HCPCS Level II code
ending in 99
If
and when an HCPCS code ends in “99”, you must provide the support documents
along with the claim. If the documents are missing with the paperwork, the
claim gets suspended by the insurance company until the documents are provided
and reviewed (this can result in delayed payment of the claims).
#2 Establish Medical
Necessity
The
patient needs to show their medical records before receiving a DME. The records
must show that there is a medical necessity for the DME to treat their
diagnosed condition. Local Coverage
Determinations (LCDs) are policies that portray the requirements for the
DME items. Understanding the specific LCDs for a particular locality will
ensure you get the correct reimbursements for the claims submitted.
#3 Streamline your
Billing Services
When
you have a DME billing system in
place, you will be able to streamline the process of claim submission. In case
of a guideline change, having an efficient billing process will help you adjust
to the changes without delaying the claims submission process.
Track
and monitor your process by outsourcing Durable Medical Equipment (DME) billing
to 24/7 Medical
Billing Services. Our team can help you identify the issues and realize the
full potential growth of your clinic.
About
24/7 Medical Billing Services:
We
are a medical billing company that offers ‘24/7
Medical Billing Services’ and support physicians, hospitals, medical
institutions and group practices with our end to end medical billing solutions.
We help you earn more revenue with our quick and affordable services. Our
customized Revenue Cycle Management (RCM) solutions allow physicians to attract
additional revenue and reduce administrative burden or losses.
Contact:
24/7
Medical Billing Services
Tel:
+1 888-502-0537
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