Medical Equipment

  • DME Billing Services
    BLOG-Physician-Liability-for-DMEPOS-Medical-Necessity

    Physician Liability for DMEPOS Medical Necessity

    The Medicare program only pays for health care services that are medically necessary. In determining what services are medically necessary, Medicare primarily relies on the professional judgment of the beneficiary’s treating physician, since he or she knows the patient’s history and makes critical decisions, such as admitting the patient to the hospital; ordering tests, drugs, and treatments; and determining the length of treatment. In other words, the physician has a key role in determining both the medical need for, and utilization of, many health care services, including those furnished and billed by other providers and suppliers. Physicians are required to certify to the medical necessity for any service for which they submit bills to the Medicare program. Physicians are involved in attesting to medical necessity when ordering services or supplies that must be billed and provided by an independent supplier or provider. Medicare requires physicians to certify to the medical necessity for many of these items and services through prescriptions, orders, or, in certain specific circumstances, Certificates of Medical Necessity (CMNs). These documentation requirements substantiate that the physician has reviewed the patient’s condition and has determined that services or supplies are medically necessary. Two areas where the documentation of medical…

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  • DME Billing Services
    Advantages of outsourcing Durable Medical Equipment billing

    Advantages of outsourcing Durable Medical Equipment billing

    Administrations of Durable Medical Equipment billing (DME) can be a tedious and time-consuming task. In addition to other things, it requires inside and out knowledge of reimbursement rules of Medicare, Medicaid and Commercial Plans, and their admonition. It likewise requires consistent adherence to quality and staying side by side of the considerable number of change events in repayment regulations and coding and documentation prerequisites. When you outsource your medical billing operations, the billing team focuses exclusively on the filing of claims, so there is no pressure on them to treat urgent patients or save lives. They take the workload off your back, freeing up your doctors and team to focus on other matters. There are several advantages of outsourcing Durable Medical Equipment Billing, some of the advantages are listed below: More Control: It is a common misconception that by outsourcing your medical billing services you can lose control over your business processes. In fact, many people feel that they have better control over their medical billing processes and the money involved due to a trained and dedicated outsourced billing staff. This increased control directly ties in with your operational benefits, which stand to benefit from outsourcing. Increased Revenues: Employing staff…

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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 happen 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
    Which DME medical supplies are covered by Medicare Part B?

    Which DME medical supplies are covered by Medicare Part B?

    Durable Medical Equipment Billing is somewhat unique if we compare it with other specialty billing. Basically, Durable Medical Equipment (DME) gives therapeutic benefits to patients experiencing certain healing conditions and/or some diseases. So a DME is built to serve the medical purpose of patients for regular use at home or in a hospital or any other healthcare unit. Standard DME products (Part A and B) include: Wheelchairs Orthotics Slings Supports Cranes Pressure sleeves Nonetheless, it is astonishing that apart from the significance, DME billing has lots of uncertainty around it. It is extremely appalling that despite DME suppliers getting an adequate doctor prescription for provisions, they frequently struggle to cover their said revenue/income. Distinctive DME organizations have diverse DME billing styles relying upon the frequency. A few organizations charge consistently as and when required while a few others charge a couple of times as the year progressed. DME billing should be to a great extent be careful and precise as a single billing and coding error can lead to a major loss thousands of dollars for the DME merchant. The doctor may suggest a DME provider or the patient should look for one in his region. But, in any case,…

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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 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 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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