Revenue Cycle Management (RCM)

  • 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…

    Read More »
  • DME Billing Services
    Recent-Policy-Development-for-Durable-Medical-Equipment-Billing

    Recent Policy development for Durable Medical Equipment (DME) Billing

    The US Healthcare industry in its true sense is passing through a transition period, where each medical specialty is waiting on the fence, to find out if there is any further development to their current regime. In those specialties, the Durable Medical Equipment suppliers are also looking for information and updates that would normalize their business, streamline the revenue cycle and are hands-on with their DME billing and coding procedures. The use of durable medical equipment in the home, while not a recent development, was formally recognized by the Congress with the passage of the original Medicare legislation. Since that time the statute has been amended to provide for a more workable, economical, and desirable interface among the administrative, supplier, and user communities. So with regards to renting, purchasing or repairing and maintenance of Durable Medical equipment here are some developments you should keep in mind for perfect reimbursement. Durable medical equipment billing recent policy developments: As a thumb rule, DME requires a prescription to rent or purchase, as applicable, before it is eligible for coverage. Certain items must be rented and may not be purchased (under “Capped Rentals”). Certain other items must be rented prior to being converted to…

    Read More »
  • DME Billing Services

    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.…

    Read More »
  • DME Billing Services
    Outsource-DME-billing-Do-you-really-need-it-This-will-help-you-decide.jpg

    Outsource Durable Medical Equipment (DME) Billing: Do you Really Need It? These will Help You Decide!

    Durable Medical Equipment Billing is a $1 billion industry which includes only the income for the providers. Insurance companies/ Medicare (payers) along with outsourcing medical billing companies act as the needed resources for the DME providers. As we see DME providers reaching out to the payers and regulators for more transparent payment model we are here to weight your options. Before we dive into understanding the requirements from you for DME medical billing We need to understand the guidelines laid for a Durable Medical Equipment (DME) Billing. A prescription is required to rent or purchase, as applicable, before it is eligible for coverage. Certain items must be rented and may not be purchased. Certain other items must be rented prior to being converted to purchase in accordance with BCBSNC medical policy.  All the bills for the DME should be typed on CMS-1500 (version 08/05) claim form. The entire applicable modifier should be applied after all HCPCS codes. All the bills for maintenance and repair should be first applied before the procedure code.  All the equipment’s for which maintenance and repair work is done a claim needs to be submitted. Use E1399 or other miscellaneous HCPCS codes only if no suitable…

    Read More »
  • 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 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…

    Read More »
  • DME Billing Services
    a-bid-program-for-durable-medical-equipmentdme

    A bid program for Durable Medical Equipment(DME)?

    Recently the Medicare Payment Advisory Committee (MedPAC) made payment policy recommendations for non-competitively bid Durable Medical Equipment. And if internal reports are to be believed, MedPAC plans to recommend that CMS shift more products away from the excessive fee schedule to bid rates. Also, it plans to call for immediate reduced payment rates for certain non-CBP products, while CMS works on incorporating them into the CBP. Alternatively, there are plans to recommend a policy option that would have CMS consider capping balance billing (specialty billing) at a percentage of the fee schedule rate and reduce the allowed amount by 5% for non-participating providers. Shifting the Bidding Program can DMEs a fortune A new research paper published in Health Affairs found that Medicare’s competitive bidding program is expected to save CMS $25.7 billion on durable medical equipment. This amount is calculated on a 10-year basis.  The program is expected to save about as much as what large commercial insurers save by negotiating with suppliers. The research found out that the early stages of the Medicare Durable Medical Equipment Billing; Competitive Bidding Program resulted on average of 35% lower prices than the CMS’ 2010 fee schedule, which is how CMS determined payment…

    Read More »
  • DME Billing Services
    are-you-conducting-the-right-follow-up-on-all-the-dme-denied-claims

    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,…

    Read More »