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Durable Medical Equipment Billing Services

When it comes to Durable Medical Equipment (DME) reimbursement, the difficulty lies in the fact that they don’t form a complete treatment episode but a part of it and their necessity for a treatment episode depends on the physician’s recommendation. This dependency makes reimbursement of DME incidents complicated necessitating additional paperwork to record and establish their necessity for a treatment episode.

Additionally, seen from a DME reimbursement standpoint, ailments are not covered by Medicaid or Medicare as such but only such ailments as are treated with the use of DME devices. Sleep disorder is a point in case. There are various sleep disorders but only such sleep disorders are reimbursed as are treated by the use of CPAP that enjoy insurance coverage under Medicaid.

If we simplify the above facts regarding DME from a reimbursement point of view, two deductions will spring up:

  • The need to establish the necessity of a DME device within a treatment episode
  • Knowledge of the devices that are covered

The second requirement is more complicated than it looks; its coverage eligibility is circumstantial. For example, a wheel chair will be covered only when used exclusively for a permanently disabled nursing facility resident and if not included in the nursing facility per diem rates.

Outsourcing to MBC:

MBC can simplify the situation for you:

  • Our team of billers and coders have years of experience in handling DME documentation starting from the beginning to the end of a medical episode.
  • Our billers and coders can help you develop a physiological description of the client’s disease, injury, impairment, etc, and other requirements, including videos and photographs to demonstrate the client’s impairments and ability to use the equipment.
  • Our DME billers and coders can help you with the entire set of reimbursement administrative activities starting from accurate identification of the instances eligible for reimbursement through preparation of claims to submitting them.

Depending on the size and need of your set up, you can choose any service model you want. If you are an independent physician without an in-house team of billers and coders nor any need for it, you can choose our outsourced billing and coding services and we would take care of the complete range of billing and coding responsibilities for you, including preparing claims using appropriate codes and other medical details, submitting them and following up with insurance authorities for their timely reimbursement.

If you are a bigger set up with an in-house team of people handling billing and coding for you who are struggling with long-drawn procedures, bumbling software applications and medical and procedural intricacies leading to rejected claims, all your in-house operations need is streaming up of your billing processes. Our Revenue Cycle Management (RCM) consulting model can help you. We will conduct a thorough study of your operations and strip out cumbersome processes and replace them with leaner and efficient ones, identify where your in-house staff need training and help train them and recommend appropriate software applications that will be easy to use, compatible with your environment and will help you be in Medicaid and Medicare compliance more easily and seamlessly than the ones you have today.

Benefits to Our Physicians:

Through both outsourcing and consulting services, we have helped physicians, hospitals and nursing homes across all states of the US improve their revenues and time that was spent earlier on nonmedical activities. We have been able to achieve this by improving the number of reimbursed claims, ensuring their timely payment and sparing their staff nonmedical administrative activities.

Our success with DME claim turn around doesn’t just include reimbursement of fresh submissions but also resubmissions made following rejections. Our billers and coders are experienced enough to assess and address reasons for rejections and where possible resubmit claims and ensure their reimbursement by Medicaid and Medicare, helping healthcare providers avoid having to deal with an unresponsive and lumbering post-submission process which often gives them a hard time.

The highlights of our services have collectively helped healthcare providers overcome the problems associated with DME devices and concentrate on delivery of care.

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