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 claim for.
Keep in mind that documentation and pre-approval is the key. And when you think you have enough, go for one more item to make sure you have a strong claim.
Do remember that Durable Medical Equipment is one of the stringent and watched aspects of medical billing and coding. This is due to the amount of fraud that has been committed by dishonest people.
Here are some important guidelines for handing your DME medical billing claims:
- Ensure you have the required letters of medical necessity/doctor’s prescription on hand to prove a legitimate need.
- If pre-approval is required for equipment, services or procedures, make sure you have that documentation on file.
- There may be an exclusion of certain equipment or other benefits associated with the DME. The patient may qualify for a wheelchair, but not a specialized wheel for the chair to accommodate an aspect of the patient’s home.
- Usually, there are yearly or lifetime dollar limits on DME claims paid.
Medicare has the authority to set the standard for many carriers as to what they will and will not pay for in a DME claim.
To give you an example, Medicare will not pay for bathroom equipment such as commode chairs that might be needed by an MS patient. Many private insurance providers use the guidelines of Medicare and consequently exclude such equipment from reimbursement. This is where preapproval and documentation are the strong suits for getting these DME claims paid.
The codes for DME billing are broad because there can be so many different circumstances surrounding the need for this type of equipment. Durable medical equipment can be anything from a wheelchair to cochlear implants to complete or partial prosthetics.
For this reason, it is important to note not only what kind of durable medical equipment is required, but also what conditions caused the need for this type of equipment. Ensuring this will make the coding process simpler for DME billing companies and will allow the insurance company to have a better understanding of the diagnosis and procedure.