Medical Billing

  • DME Billing
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    Durable Medical Billing (DME) facilities need outsourcing medical coding?

    With over 19 years of experience in Durable Medical Billing (DME) through errors and compliances, we have understated a few paths for DME clients. Every month we add new clients with thousands of dollars are lost in mishandling and unpaid claims in numerous fields of healthcare, including Durable Medical Equipment (DME). Added to this is the multifaceted billing and coding procedures, and the claim requirements of Medicare, Medicaid, and other private insurance companies. To ensure accurate reimbursements and timely revenues, it is imperative to hire an outsourcing agency as it works as a smart solution and completes all the billing and coding requirements; and assists in organizing the entire processes at a fraction of the in-house operating costs. It also makes the in-house billing and coding department’s work a lot easier, less time consuming, and lesser issues related to legalities. Equipment which provides therapeutic benefits to patients who are in need due to certain medical ailments is categorized as DME. It is also known as Home Medical Equipment (HME) and is able to withstand repeated use. Equipment’s considered as DMEs are prosthetic devices, wheelchairs, oxygen equipment, insulin pumps, walkers, hospital beds, power mobility devices, etc. It is known that around…

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  • DME Billing
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    CMS Relaxes the Date for CURES Act Changes for Durable Medical Equipment (DME) Billing

    CMS has now backed off from the initial date of Dec 31, 2017, and stated that it will work with state Medicaid programs for a different compliance and reimbursement plans. CURES ACT related to Medicaid update was first released in early December. In a view of various physicians and surgeons, CMS has now revised the ruling stating that Medicaid directors will not have an impossible deadline and will look to seek a more collaborative approach related to the compliance. The original letter dated Dec 27, 2017, stated that state Medicaid programs had to notify CMS of their decision of aggregate payment comparisons or alternative approach to compliance. This gave state programs a few days to make an important decision on medical billing. The new guidance issued by CMS on 4th Jan gave in the more flexible structure of guidelines for the state programs to follow. State facilities that decided to change their state Medicaid plan for the DME payment. For this the facilities who pay at or less than Medicare rates for the DME products or the facilities who have amended the state developed fee schedules, all the above facilities must submit a state amendment plan by March 31, 2018.…

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  • DME Billing
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    Increase Collection of Durable Medical Equipment (DME) Provider’s

    Medical billing and coding is an integral part of your revenue cycle management. It not only concentrates on posting accurate payments but invariable increase the collection of your facility as well. Today, most medical facilities, solo practitioners, healthcare units and clinics employ dedicated medical billing and coding companies to optimize the entire income cycle. This way, they can fully concentrate on their core undertaking, while the experts at charging do their job. In simple terms, Durable Medical Equipment refers to wheelchairs, braces, shower chairs and other assisted living equipment needed by the patients. These gears are generally purchased as an outpatient entity. Preapproval in DME billing is critical It does not matter if your patients are insured through Medicare, Medicaid, and Workers’ Compensation or through a private insurance carrier. Almost all DME claims must be pre-approved prior to submission of the medical billing claims. Many of these policies have strict guidelines, which must be followed in order for the DME medical billing claim to be reimbursed. Some providers will require that the DME be purchased through their own sources and have a listing of specified providers. Many HMOs are very strict about the DME they will reimburse a medical billing…

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  • DME Billing
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    Are You Conducting The Right Follow Up On All The DME Denied Claims?

    Getting to know the basics of denial management is vital for successfully running a medical practice and Durable medical equipment (DME) facility. Facilities that are showing positive bottom line numbers at the end of each month will generally have denial rates below 2%-3%. Also, nowadays payers are embarking system software’s so they can identify different payment procedures which apply the contract requirements. For some insurer’s, it seems that the procedure is skewed to effect denial, whenever anything is unclear. Along with this, most insurance companies expect only a fraction of DME facilities to follow-up on the claim and re-submit a corrected version. Clearly, producing clean claims saves facilities money. Indeed, even with the rising number of claims being denied all the time, DME facilities must not lose heart. There are numerous ways to answer the issue of, how to rectify increasing claim denial rates. Practices can obviously target regular zones of through where a claim denial occurs, but looking beyond the traditional norms is not just enough. Today, even a minute DME billing and coding mistake can lead to a denial or delayed reimbursement. And in such a scenario, if you are not applying the right kind follow up procedures,…

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  • DME Billing
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    Digging Deep in DME coding: External Elements that streamline your Medical Billing

    Medical billing and coding from the outside may look like an easy on the run job, but it has much more intricacies that what you can imagine. The Durable Medical Equipment charges, which have different ‘codifications’, altogether are is making life worse for DME owners to sustain a streamlined revenue cycle, as most of the claims are being denied or delayed due to incorrect coding or billing information. The moot question that arises here is how can DME suppliers go to the root cause of the daily coding issues. Can they use external elements to streamline their entire billing cycle and aging AR days? Let’s find out. If you are into medical billing and coding, durable medical equipment may scare you as its coding complexities are deeply rooted in HCPCS or Healthcare Common Procedure Coding System Level II codes and Medicare’s policies. Not to worry, as there are many ways to fine-tune your DME coding abilities by digging into the DME and exploiting how to properly assign HCPCS Level II codes for billing. Firstly, one needs to start by getting their hands dirty and scooping away the top layer of DME by defining it. Next, you need to dig deeper…

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  • DME Billing
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    Durable Medical Equipment: Most Simple Things You Need to Know

    With age, there comes a dependency.  We may require assistive equipment to help us do things that were earlier easy, such as climbing stairs or standing up from a chair. The majority of older adults have never previously encountered this type of adaptive equipment, and navigating this new world of insurance and vendors can be overwhelming. That’s why you need to know about Durable Medical Equipment widely termed as (DME). What Is Durable Medical Equipment? Durable medical equipment is things that are most familiar as hospital beds, commodes, wheelchairs, items like that that are needed for a patient or client to help them function with their daily living. There are some things that we all see in the hospital that you can have at home. Some things you need to have and some things are just a convenience. Not just for people who are old and aged, DME also fits all the below mentioned criteria: How Is The Coverage Offered For DME? DME is generally covered subject to the indications listed below: Durable Medical Equipment (DME) and orthotic benefits, including certain disposable supplies, enteral feedings and the following diabetic supplies and equipment: glucose monitors, insulin pumps, syringes, blood and urine…

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  • DME Billing
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    Best Practices to Optimize your AR days for DME facilities

    A professional DME facilities and billing workflow ensure to have increased revenue. With errors and mistakes in your DME billing, the process for claims management is hindered and thereby the Accounts Receivable (AR) collections have a deep impact overall reducing the healthy cash inflows. So what are the best practices to optimize your AR days for DME facilities? Here are some 5 simple yet effective ways to make effective your billing efficiency and thereby speed up the A/R collections at your practice Authentication & eligibility of insurance coverage This is most necessary to make sure that when the DME services are billed, patient’s insurance coverage has been confirmed and the services/equipment are covered by the insurance or by the Medicare. If not, this could lead to delays in payment and resubmissions which could prove costly in the long run Trained in-house staff or Get Outsourced expertise No matter what you go for in-house DME billing or outsource, workers employed in handling the claims submission need to be knowledgeable about the different rules and requirements for claims submissions. The healthcare regulation changes can impact the RCM process and DME services can see reimbursement rates drop by 60% percent at any given…

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