DME Billing For Medicare Part B
With
old age, assistance and assistive equipment become essential to help us do
things that were natural to us once—for instance, a walker to move and walk
around easily without a nurse. But for many older people, the world of
insurance and vendors can be pretty overwhelming, mainly when it comes to
purchasing Durable Medical Equipment (DME).
But
the challenges of navigating the world of DME are not only for the end-users,
i.e., the patients, but also for the DME service providers. The facility is
different from any other services in the medical field, which makes DME
billing and coding more challenging.
Since
DME is given to patients to avail of the therapeutic benefits for certain
health conditions or diseases, it is also used at the home, hospital, or other
healthcare units regularly by the patients in many cases.
What are Standard DME
Products?
Within
the standard DME products, there are two parts, Part A and Part B, which
include:
·
Cranes
·
Orthotics
·
Pressure
Sleeves
·
Slings
·
Supports
·
Wheelchair
Despite
becoming an essential requirement for the increasing aged population, DME
billing is shrouded with lots of uncertainty. As a result, many DME service
providers, despite having the proper doctor prescriptions for the services many
DMEs struggle to reimburse the money for the services rendered.
Details about DME Billing
for Medicare Part B
As
mentioned earlier, DME billing is categorized into two parts, Part A and Part
B. In Part B, there are certain restrictions on the coverage of medical
supplies. The section offers the benefit of equipment to the patients medically
necessary as prescribed by the physician. The equipment can be used at home,
but the supply has to be prescribed and purchased from providers who belong to
the Medicare program to get the benefit. Furthermore, the supplier also needs
to accept and adhere to the DME Medicate regulations.
In
most cases, for the Part B benefit plan, the patient has to pay 20% of the
allocated amount under the Medicare allowance for the DME. But before that, the
patient needs to meet the Part B applicable deductible amounts.
It
is also important to note that the DME supplies or equipment can be subjected
to competitive bidding in some regions of the country where a patient resides.
Medicare introduces the process as part of a cost-saving initiative. It helps
the healthcare costs align with the item’s actual purchasing price. If a
patient has Medicare coverage that stands under the bidding program for DME,
they must use a supplier contracted with the Medicare program. Failure to do so
will result in the patient not getting the benefit from Medicare.
Which DME are included in
Medicare Part B Plan?
Here
is a list of the supplies and equipment that falls under Medicare Part B and
can be reimbursed.
·
Commode
chairs
·
Continuous
Positive Airway Pressure (CPAP) along with its devices and related supplies to
·
equipment and
supplies for Enteral nutrient
·
Hospital beds
and their accessories
·
Standard
nebulizer and its related supplies
·
Negative
Pressure Wound Therapy (NPWT) along with pumps and related supplies
·
Oxygen, its
equipment, and other related supplies
·
Patient Lifts
·
Seat lifts
·
Walkers
·
Wheelchair
and its accessories for both manual and standard power
·
RADs
(Respiratory assistant devices and the related supplies
·
Mobility
scooter and the related accessories
·
Group 1 and
Group 2 support surfaces
·
TENS
(Transcutaneous Electrical Nerve Stimulation) devices
·
Diabetes
testing supplies (mail-order only)
How is the DME Billing
Done?
DME
service providers should be extra careful and succinct with the DME billing and
coding, regardless of whether they charge regularly or twice a year. A single
error will lead to the loss of thousands of dollars for the service provider.
It
has been observed that several DME organizations charge consistently across the
financial year, and some facilities charge only a few times every year. While
doctors might recommend a patient find a DME provider in their region, patients
can choose a DME supplier of their preference.
What should DME do to Provide
the Equipment?
Whether
the DME equipment falls under Part A or Part B category, the DME suppliers
should adhere to specific activities when providing the equipment to the
patients. Some of them are:
·
Ensure proper
and legitimate delivery of the equipment and setting it up for the patient
·
Check and
ensure that the condition of the facility, e.g., home, hospital, clinic, or
nursing home, is sheltered and has the optimum condition to warrant the best
possible use of the equipment.
·
Train the
patient, family, or caregiver to operate and use the equipment in the best
possible way and upkeep it.
·
Giving the
patient or the caregiver the necessary information on the usage and maintenance
of the equipment.
All
of these- all the DME suppliers and service providers have to give consent to
the HIPPA (Health Insurance Portability and Accountability Act) to ensure all
the documents and records of the patients are secured and cannot be accessed without
the proper authorization.
How can DMEs with Part B
Plan ensure Correct Billing?
The
discussion on how DMEs lose money due to incorrect DME coding, adding
modifiers, or failing to provide the required document has been a hot topic in
the healthcare industry. Often the facility fails to give the necessary
documents to support the equipment requirement, resulting in claim denials or
rejections. While the DME service provider also has to check whether the
patient is covered by Plan B to get the money, it becomes challenging to
scrutinize every detail.
24/7
Medical Billing Services, your outsourced DME billing partner is your best
choice for such an instance. As a DME billing and coding service provider, we
ensure that the patient is covered by Plan B for DME and also follow up with
the payers to ensure you do not lose the revenue. Our specialized DME billing
experts provide support to all DME facilities with their billing and coding
process and better RCM to warrant an improved ROI and better scalability.
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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