4 Inside Secrets of DME Billing

As a physician when billing for DME services, the process can be very complicated and tiresome. However, there are ways and means to work with this, so that ancillary revenue need not be lost.

Often healthcare providers write prescriptions for patients, who then have to procure the DME product from the DME provider. But, do you know that you as a physician can also dispense DME products from your office premises and bill accordingly, thereby receiving ancillary cash flow and also keeping your customers happy?

Here are some insider tips to a smoother DME billing that can help the Revenue Cycle Management(RCM) reimbursement process get a boost:

DMERC license

To dispense Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), one must have a Durable Medical Equipment Regional Carrier (DMERC) license to dispense covered items for Medicare patients.

Coverage and eligibility

Verifying the coverage and eligibility of your patients is the next step toward streamlining the DME billing process


This is most essential when it comes to DME coding & amp; billing. Employing the correct HCPCS code to use for a specific item is what will help process your claim faster. The documentation should meet the “medically necessary” that DME products require when being billed. Documentation should be able to show the way, the what, the when, and the where of the DME product being billed. Stringent documentation helps easy coding and thereby efficient billing

Rules & regulations

Having knowledge of the new rules and regulations by the CMS and the private payers is very essential. Different payers can have different rates for DME products. It is worthwhile to also remember that the rates for DME products and the percentage of it reimbursed by the CMS can also vary. So having one person just keep up-to-date with all this information and processing the claims before submission, running them through the checklist, would be appropriate. This would not only bring down denial/rejection rates but would also help seamlessly streamline the RCM process, especially where DME services are concerned.

The above 4 pointers are very essential to any physician trying to handle DME services. Outsourcing just the billing & claim submission part would also be appropriate given that the staff there would have the bandwidth to keep updated about the codes, modifiers, and changes as per the rules and regulations of both state and federal health departments and private insurance payers too.

4 Inside Secrets of DME Billing | Every Physician should know