When it comes to Durable Medical Equipment (DME) reimbursement the difficulty is 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 which enjoys insurance coverage under Medicaid.
If we simplify the above facts regarding DME from a reimbursement point of view, two deductions will spring up:
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The need to establish the necessity of a DME device within a treatment episode
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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.
Our medical billers in Hawaii aim to provide you to the best Medical Billing services with maximum efficiency. For almost 10 years in the industry now many of them have been involved in all aspects of medical billing, coding, collections and compliance to HIPAA guidelines. Our billers are located in all the major cities like Honolulu, Hilo, Kailua, Kaneohe and Kapolei. Their skills across the following can help your practice to thrive:
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Patient demographics Entry
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Filing of Electronic claims
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Follow up on outstanding and denied claims
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Auditing Codes with ICD-9 and CPT
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Timely Payment posting
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Providing reports on a regular basis to show claims status
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