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:
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.
Massachusetts, the state with one of the highest taxes is considered one of the most affluent states, but the cost of healthcare is considered as one of the basics and physicians across the state are trying to reduce healthcare costs. Experts working on your reimbursement make sure you have better collections.
Since the last 10 years our medical billers and have been providing medical billing and coding as well as accounts receivables follow up and practice management service to Massachusetts physicians.
Certified medical billing and coding professionals who have an extensive experience in all specialties, are available in all cities such as Boston, Worcester, Springfield, Lowell and Cambridge. They have shown skills for lowest claim denials and fastest reimbursement. Some of the services which our medical billers are proficient in are;
Electronic claims submission
Tracking of claims
Customized monthly report