ICD-10 and DME Billing- Does Outsourcing Spell More Revenue?

DME Medical Billing.

The challenges facing the Durable Medical Equipment (DME) organizations with the upcoming ICD-10 coding system are plenty. Although the DME you bill for will still employ the same HCPCS codes, the actual difference will be in the diagnosis coding itself.

    • Firstly, the transition from ICD-9 to the new ICD-10 coding system has led to an increase in the number of codes for procedures from 3,824 to 71,924, and simultaneously has also increased the number of codes for diagnosis from 14,025 to 69,823.
    • Secondly, there are few one-to-one, cross-walked codes in the ICD-10
    • Thirdly, it is a known fact that the DME providers receive meager information from the physician to convert the codes accurately thus leading to delays in claims causing a shortage in cash flow.
    • Fourthly, reimbursement of DME incidents needs to establish the necessity of a DME device within a treatment episode and the knowledge of the device that covers it. A more accurate identification of the treatment episode that makes the use of the device eligible for reimbursement is now more than ever required

Fifthly, software updates are required, and the capital investment will increase given the training of the staff. Moreover, the labor intensive work like handling of dual code sets much after the October 1 2015 deadline until all is ironed out, the change in business documents like contracts, bills, training and operation documents, etc. associated with ICD-9 codes will all need to be updated.

Is your in-house staff ready to deal with the above 5 challenges? Wouldn’t you prefer them to concentrate on their practice priorities? One way to get this done will be by Outsourcing DME billing. But, if you weigh the pros and cons of outsourcing, the pros definitely work towards an increase in cash flow, at least in the beginning. Keeping a tight control over certain aspects of the outsourcing will be a win-win. The reasons how outsourcing can help improve your revenue

  • The outsourced billers and coder are well versed with the Medicaid, Medicare, and private health plans
  • They are experts in knowing, negotiating, and responding better to dynamics of DME billing
  • Expertise in the transition from ICD-9 to ICD-10 and HCPCS coding will lead to decreased denials. They are also well versed with what treatment episodes require what devices and can immediately pull in the information
  • All the labor, operation and administrative processes, and the capital investment required for the transition can be taken care by the outsourcer while your staff can concentrate on their priorities

For DME providers, to make the ICD-10 transition smooth, outsourcing the administrative and operational part can help make this deadline a lot more smoother and easier to deal with not just prior to October 1 or later, but for many more years down the line.