Month: September 2016

  • DME Billing
    Overcoming-challenges-faced-by-physicians-prescribing-DME

    Overcoming challenges faced by physicians prescribing DME (durable medical equipment )

    It is well known to physicians that durable medical equipment (DME) services are ancillary to the primary clinical purpose. However, most physicians are also aware that when prescribing DME, they may not get the reimbursement due to them as their admissibility is subject to certain conditions. There may be a number of reasons why physicians who prescribe DME to their patients, their claims are often denied or rejected. The reasons could be due to: Deemed medically unnecessary They did not have the proper credentials and thus deemed Uncertified by Medicare/Medicaid/private health insurers They have claimed beyond the permissible reimbursement level Have not met certain regulations & compliances set down  by the Healthcare Common Procedure Coding System (HCPCS) One of the major setbacks faced by physicians is the lack of drive to back their recommendation with sufficient proof of the service rendered being medical necessary. And this is due to bad processes in verification & documentation, which leads to low resubmission for claims and thus losing a lot of reimbursements affecting their Revenue Cycle Management (RCM) process. Moreover, in 2015, Medicare had a 40 percent improper payment rate for durable medical equipment, prosthetics, orthotics, and supplies, resulting in $3.2 billion losses.…

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