DME billing and coding is a very complex system and involves a certain level of expertise. Besides expertise, awareness, and knowledge about the constantly changing coding system by CMS help ensure accurate billing that helps reap rewards.
Here are a few ways that can help ensure accurate billing for DME services:
- Awareness of kinds and types of modifiers: Modifiers are known to influence fee schedules and help fix prices paid for DME. Moreover, the reimbursements for rental and purchase are not always the same. Each modifier should be studied in detail, understood what they mean and when each can be used appropriately.
- Coding when using components and accessories: especially wheelchairs carry specific codes for components and accessories of wheelchairs which need to be employed appropriately
- Terminology: It is imperative to know how and when specific terms can be employed to ensure accurate billing. For example, a power wheelchair with attachments like a basket or headlights may not be classified as “custom” and can only be termed a wheelchair with extra options. Here, HCPCS is appropriate for the base and the extra components can be billed under a separate heading.
- Operational Protocols: To ensure accurate billing, the need to establish operational protocols is necessary. The need to comply with face-to-face encounter requirements mandated by the Affordable Care Act (ACA) for certain items of Durable Medical Equipment (DME). The physician must document that the physician, PA, NP, or clinical nurse specialist (CNS) has had a face-to-face encounter with the beneficiary within six (6) months prior to completing the detailed written order.” Pas, NP, etc may provide the dispensing order and write and sign the detailed written order if they satisfy all the following requirements or within certain situations as stated in the Medicare Program Integrity Manual
- Compliance: Medicare will deny Durable Medical Equipment, Prosthetic, Orthotic, and Supplies (DMEPOS) claims if the ordering/referring physician is not identified, not enrolled in Provider Enrollment, Chain, and Ownership System (PECOS), or not of a specialty type that may order/refer the service/item being billed.
With the knowledge of the above and some help from a coding specialist, you can be assured that the billing of DME services ensures that claims will not be denied and the process will be smooth to pave the way for an effective Revenue Cycle Management (RCM) system