Medical Coding

  • DME Billing Services
    Know your DME HCPCS Codes

    Know your DME HCPCS Codes

    In DME medical billing, your DME coders require correct HCPCS codes along with correct modifiers that are used for providing more details about the equipment. If your medical coders are unable to use modifiers or not using them in the correct manner, then the claims may get denied from the insurance company. Some common DME modifiers which include RR- rental, UE- purchase of used equipment, and NU- purchase of new equipment. When a laboratory demand, request for DME is being filled, medical coders will be needed ICD-10 codes for a patient’s diagnosis. To use an appropriate HCPCS code for the DME item, many HCPCS codes need a modifier. Modifiers are used to provide more details about the DME item. e.g. The modifier might indicate HMSA that an item is new, rented on a capped basis, or rented. For capped rentals, modifiers differentiate which month’s rental is being billed. If your billers use these modifiers incorrectly then the claim will be rejected. To speed up this process of your claims, show the first-month rental by adding the appropriate modifier code and bill your claims in successive order. HCPCS Code Range: E0100-E8002: Durable Medical Equipment E0100-E0159: Walking Aids and Attachments E0160-E0162: Sitz Bath/Equipment…

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  • DME Billing Services
    Critical factors to consider before you outsource DME billing and coding

    Critical factors to consider before you outsource DME billing and coding

    Durable Medical Equipment (DME) as a healthcare industry field is different from other specialties and so is its medical billing and coding requirements. You need an in-depth and specialized knowledge of all the updated HCPCS Level II codes as DME claims are classified under HCPCS Level II. And as to speak about DME suppliers, the complex nature of reimbursement is another challenge they constantly face. Since patients can rent expensive equipment rather than purchase, DME billers and coders must be conscious of exactly how to code claims and when to send them for getting the precise reimbursement amounts. What this means is that the code should lay down the equipment was rented and not purchased. The rental period should be recorded separately on the claim so that the insurance company will pay a small reimbursement for each of those days. Outsourcing your DME medical billing tasks facilitates a smart solution for your hospital billing requirements, assisting you to organize the entire billing and collection process at a portion of your current operating costs. If you want to make the in-house workload a bit lighter, it’s a great idea to consider outsourcing your DME billing. Here are some important ways by…

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  • DME Billing Services
    Updated-DMEPOS-Codes-Fee-Schedule-2019

    Updated DMEPOS Codes Fee Schedule 2019

    The Centers for Medicare & Medicaid Services (CMS) updates the DMEPOS Codes Fee Schedule on an annual basis in accordance with statutes and regulations. Payment on a fee schedule basis is required for certain Durable Medical Equipment (DME), prosthetic devices, orthotics, prosthetics, and surgical dressings by Section1834 (a), (h), and (i) of the Social Security Act (the Act). Additionally, payment on a fee schedule basis is a regulatory requirement at 42 Code of Federal Regulation (CFR) Section 414.102 for Parenteral and Enteral Nutrition (PEN), splints, casts, and Intraocular Lenses (IOLs) inserted in a physician’s office. The DMEPOS and PEN fee schedule files contain Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the adjusted fee schedule amounts under Section 1834(a)(1)(F) as well as codes that are not subject to the fee schedule Competitive Bidding Program (CBP) adjustments. New Codes Added New DMEPOS codes added to the HCPCS file, effective January 1, 2019, where applicable, are A4563, A5514, A6460, A6461, B4105, E0447, E0467, L8608, L8698, L8701, L8702, V5171, V5172, V5181, V5211, V5212, V5213, V5214, V5215, and V5221. The new codes are not to be used for billing purposes until they are effective on January 1, 2019. As part of…

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  • DME Billing Services
    Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule Update 2019

    Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule Update 2019

    CMS happens to announce in the year 2019 about Medicare fee schedule rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). The 2019 update factor is 2.3%, although other pricing policies are applied in specific circumstances. The DMEPOS and PEN fee schedule files contain the Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the adjusted fee schedule amounts under Section 1834(a)(1)(F) as well as codes that are not subject to the fee schedule Competitive Bidding Program adjustments. For CY 2019, the following Fee Schedule Adjustment Methodologies apply and fee schedule amounts are based on the area in which the items and services are furnished. Fee Schedule Amounts for Areas within the Contiguous United States To determine the adjusted fee schedule amounts, the average of Single Payment Amounts from CBPs located in eight different regions of the contiguous United States are used to adjust the fee schedule amounts for the states located in each of the eight regions. These Regional SPAs or RSPAs are also subject to a national ceiling 110 percent of the average of the RSPAs for all contiguous states plus the District of Columbia) and a national floor (90% of the average of the…

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  • DME Billing Services
    durable-medical-billing-facilities-need-outsourcing-medical-coding

    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 that 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 Services
    Increase-Collection-of-Durable-Medical-Equipment-Provider.jpg

    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 the 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…

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  • DME Billing Services
    lacking-in-ar-management-can-harm-your-durable-medical-equipment-revenue

    Lacking in AR Management can Harm Your Durable Medical Equipment Revenue

    Accounts Receivable (AR) is a key parameter in the financial division of every healthcare facility. It is defined as the money owed by the healthcare facility for the services rendered to the patients. Being a vital aspect of the revenue cycle management, the cash flow of the healthcare facility is directly proportional to the managing of AR. AR is calculated as: Total charges for last 6 months/number of days in last 6 months = average daily charges Total AR / average daily charges = days in AR AR can be duly managed if the medical billing and coding professionals are knowledgeable about coding parameters, insurance rules, timely claim filing and follow up (of regular and rejected claims). Usually, the healthcare facility is paid by the insurance and the patient. A delay in either of these negatively affects revenues and leaves a great deal on the table. Hence, it is imperative to monitor the AR on a continuous basis. And this must be done by professionals who know the healthcare practices’ contract terms claims adjudication. The professionals managing AR must also know how to calculate copays which the patients are required to pay. Other practices to be followed are: prior authorization,…

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