Durable Medical Equipment (DME) is the equipment which includes oxygen supplies, wheelchairs, iron lungs, catheters etc. As you are starting a Durable Medical Equipment (DME) company, be prepared with time on hand, money, endurance and determination; as it ultimately boils down to being paid for the products sold by your company. This means receiving DME bills from clients (patients/healthcare providers) and accepting the insurance, billing the insurance, and finally receiving payments for the DME billing from the insurance provider.
DME business also referred to as Home Medical Equipment business, is replete with potholes along the way which need to be cleared. One of them is ‘Provider Credentialing.’ Credentialing simply denotes verification. It’s also known as DME credentialing, DME medical credentialing, DME provider enrollment, insurance credentialing or getting on insurance panels. These terms imply that the patient is going to pay through insurance and your company is “In Network” with the insurance companies. And, as you go on to be accepted as provider (post credentialing), receiving payments of DME billing through this process is known as “In Network” provider. It also implies acknowledging more clients along with on-time and accurate payments. There are a number of companies through which a DME company can/should be credentialed with; government organizations like Medicare, Medicaid or Tricare and other big players (commercial insurance) in the market such as Aetna, BCBS, UHC, Cigna etc. Smaller companies could be targeted too as they have immense potential with respect to a greater number of clients and comprise lesser competition.
DME credentialing process:
1. Obtain an office space.
2. Acquire a business bank account.
3. Obtain a business organization and a set location.
4. Organize all documents: Information on license, background, insurance, resume. Also, double check that the application has been signed, dated and holds a legal document- Unique Federal Tax ID#.
A DME provider credentialing usually takes around 90 to 120 business days for 8-12 carriers. This is the stage for approval and denial. Post credentialing, you move towards ‘Contracting’ which states your eligibility to be in the network of insurance providers. Here, the insurance company sends a contract to be read and signed by you and the doorway to the network occurs in the next 30-60 days.
Note: Centers of Medicare and Medicaid Services (CMS) approved 10 national accreditation organizations that will accredit suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) as meeting new quality standards under Medicare Part B. In order to enroll or maintain Medicare billing privileges, all DMEPOS suppliers (except for exempted professionals and other persons as specified by the Medicare Improvement for Patients and Providers Act of 2008) must comply with the Medicare program’s supplier standards (found at 42 CFR §424.57 (c)) and quality standards to become accredited (www.cms.gov).
Understand that no insurance company acknowledges preceding claims before acceptance in the network. Hence, it is always better to start the credentialing process early to avail benefits and reimbursements.