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.
For over a decade now, our West Virginia medical billers and coders have made the investment of time, money and experience so as to ensure that your practice enjoys a satisfactory billing experience. Our coders are certified professional coders and are there to into the correct coding of your claims.
They are fully trained to understand and apply HIPAA compliance into your clinic’s operation and can look into the coding of your claims to give you an assurance of CCI and LMRP compliance. Our medical billers and coders are active in a number of West Virginia cities such as Charleston, Huntington, Parkersburg, Morgantown and Wheeling and provide services like:
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Daily entry of charges
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Payment postings on a daily basis
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Daily filing of electronic claims to Medicare, Medicaid and other commercial insurance carriers
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Appeals and denial follow up
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Monthly patient billing
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Monthly financial reports
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