DME Billing Coverage Limitations And Exclusions
Durable
medical equipment (DME) billing is an essential aspect of revenue cycle
management in the healthcare industry. As the industry evolves, DME has grown
in importance and now serves millions of patients. However, managing the
billing processes and reimbursements associated with DME can be time-consuming
and labor-intensive.
DME
billing is becoming more of an administrative burden for healthcare providers
as regulatory requirements continue to grow. In fact, the DME billing process
is prone to numerous mistakes and errors due to such complexities. If not addressed
properly, these errors can result in claim denials or rejections, resulting in
significant losses for the DME provider. Here are some of the most common DME
billing requirements one must be aware of to receive the adequate reimbursement
amount for the services provided.
What
is DME Billing?
The
process of generating and submitting claims for the durable medical equipment
provided is called DME billing. However, DME billing does not cover equipment
or devices that are used for convenience rather than a medical need of the
patient.
What
is DME Coding?
DME
billing companies, data analysts, and coding specialists submit insurance
claims using HCPCS (Healthcare
Common Procedure Coding System) codes. This DME coding system contains
a list of all the codes used in DME billing services. These codes aid in the
tracking of supplies and equipment given to patients. As a result, Medicare and
other insurers can process health insurance claims more efficiently. HCPCS code
E0639, for example, denotes a moveable patient lift system.
DME Billing Coverage Conditions
DME
billing services can be covered only when the following conditions are
fulfilled:
·
When a patient has DME benefits
and the equipment is recommended by a healthcare professional to treat or
diagnose a long-term disease or illness, and the equipment is not otherwise
excluded in the patient benefit plan document or history.
·
DME must not be consumable or
disposable for DME billing unless absolutely necessary for the effective use of
covered DME.
·
In the absence of disease,
illness, or disability, the patient cannot use DME.
·
For outpatient use in home
settings, DME must be provided or ordered by healthcare professionals.
·
DME must only be used for medical
uses or medical purposes.
DME Billing Coverage Limitations
Being a DME biller, one should be aware of various
DME billing coverage limitations. They can be as follows:
1. If a patient uses one or more DME to meet
functional needs, coverage benefits are only applicable and available for one
DME that meets the minimum patient requirements. They are as follows:
·
Custom
wheelchair vs. standard power wheelchair
·
Standard
vs. semi-electric vs. complete electric vs. floating bed
This limitation is intended to eliminate coverage
for deluxe or additional components for a DME item that is not required to meet
the minimal requirements of patients to treat the chronic disease or illness.
2. When a patient purchases or rents a DME that
exceeds the guidelines outlined above, the patient is responsible for the cost
difference between the items or devices purchased or rented.
DME Billing Coverage Exclusions
DME billing services cover all those accessories or
devices that are primarily intended for the comfort and convenience of the
patient. However, the following DME devices are not covered by insurance
companies:
·
Air
purifiers and filters
·
Air
conditioners
·
Non-medical
equipment batteries
·
Humidifiers
·
Non-medical
mobility devices. This exclusion does not apply to coverage for Pediatric DME
billing.
·
Remodeling
or DME modification to home or vehicle to accommodate DME or a patient
condition.
How to Streamline the DME Billing
Process?
Streamlining the DME billing process can result in
higher reimbursements for your medical practice. Outsourcing to your DME
billing partner, such as 24/7 Medical Billing Services, is the best way to optimize
your DME billing workflow! Outsourcing
DME billing operations will allow you to benefit from the expertise of
DME billing specialists. You can stay up to date on policy changes, payor
guidelines, regulation updates, and so on. Moreover, these professional DME
billers and coders can help you focus on your core expertise, providing quality
healthcare to your patients. Reach our experts to know more about our DME
billing services.
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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