Items that are essential for supporting a medical need have been referred to as durable medical equipment (DME). These include ambulatory aids, special hospital beds, oxygen tanks, wheelchairs, special commodes, compressors and more. Most of the health insurance companies including Medicare term these as DME benefits, of course only whenever a doctor says there was an absolute medical necessity for using any of these items.
One curious aspect of DME billing is that though the item is described as DME, providing such items comes under HME billing, as it is essentially a home medical equipment service they are being used as. This is probably because providing home-based medical equipment services are never considered one-dimensional. Rather, such services have been considered multi dimensional as the patients who need such DME services require the items to be delivered to their homes.
DME Billing- In durable medical equipment billing, there is requirement of home assessment to ensure that the requisite safety requirements are met in the particular home for any prescribed item before it can be delivered or installed, as the case may be. Some of the home equipment billing companies insist on making sure if the equipment has been set-up by the people trained to do so.
Companies providing DME billing services also insist on the recipients going through the instructions that detail the usage and operation, as well as maintenance. In case they encounter any operational failure they need to be able to seek assistance to set things right. Clear instructions also need to be given to users/attendants on how to monitor and report changes in the medical conditions of the patients, and expert assistance in checking if there is insurance coverage for a particular piece of DME.
They also need to verify from the durable medical equipment billing companies if there is around-the-clock assistance in case of any emergency cropping up, especially during holidays or after office hours. The DME billing services providers also need to be prepared to help the patients whenever reimbursement in such cases is challenged by the insurance carriers, and advocate on their behalf to resolve issues. In case the purchase was not met, the DME items need to be retrieved from the patients’ homes, which also is considered to be part of DME services.
HME Billing- When it comes to home medical equipment (HME), the providers need to ensure that hire and train the related staff in aspects like insurance coverage provided by insurance carriers for all DME items. DME billing services includes being in communication with medical professionals and staying in communication with the ailing patients as well as the paramedical caregivers. The home medical equipment billing companies need to ensure that the proper instructions for operation and maintenance of DME items are give.
Part of HME billing services providers includes verifying whether proper sanitation and reconditioning of returned DME items was carried out and whether safe transportation practices (vehicles) and maintenance processes were adopted. The home equipment medical billing companies need to also ensure that 24/7 service was made available to the patients at their homes. FDA licensure for HME is an important requirement that has to be met. HME service providers on their part may be running hospitals in various locations. Their focus needs to be on inventory, staff, in addition to taking care of logistics and establish communication procedures in place.
While about two to three decades ago HME services were rendered by delivery technicians and respiratory therapists on a few occasions, the services today have evolved to a different level of sophistication, thanks to technological advancements. Today, highly trained clinicians holding multidisciplinary backgrounds like nurses, pharmacists, diabetic counsellors, dieticians, physical therapists, respiratory therapists and more are employed by most HME service providers. This has made HME billing services a specialized domain; hence most providers prefer to outsource home medical equipment billing to vendors who have skilled and experienced staff to take care of the billing.