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 HCPCS billing code exists. Each claim with miscellaneous codes or custom items (i.e., foot orthotics, specialty wheelchairs) must include special documentation.
- A DME provider has to submit a complete description of the equipment. With an initial claim and factory invoice for the item. A provider should also obtain a certificate of medical necessity from the physician for the equipment.
- Ensure all the claims submitted on paper should be documented appropriately and received in the same No additional documents could be transmitted electronically.
Above is the more simple documentation of DME billing for the providers. The total guideline for Durable Medical Equipment (DME) billing would be overwhelming for any provider in terms of implementing and also creating a channel to reduce the billing errors.
A DME supplier from Ohio and also a client of our DME billing service recently said during a feedback session “Outsourcing helps in focusing which I am best at. I don’t have to worry about various coding or regulatory changes which keep coming. Medical Billers and Coders (MBC) have enough resource to solve my claim problems. ”
Dr. Simmons from Florida a Woundcare physician “Many patients come to me with conditions which do require external equipment for the healing process and also maintain the normal body functions. For most, I recommend the used instruments and for some, I recommend a new but what lies after the prescription is given is the most important factor. Deductibles are most dreaded in DME billing we have to notify patients about various payments they have to make.”
The above billing challenges are just the brim of many core guidelines to be followed by DME providers for billing. This has led to the development of outsourcing DME billing to regulate and makes informed billing decision within the guidelines.
According to a recent article published by DME, the research group said that the CAGR for DME supplies would be 6.3 percent but the revenue would see a CAGR of 3.8 percent. Varied reasons would contribute to the low revenue CAGR with uncertain Affordable Care Act (ACA), error in billing regulations and guidelines and insurance policy to name some of the few.
Increase your Durable Medical Equipment (DME) CAGR with guidelines solution
Medical Billers and Coders (MBC) a leading medical billing service provider with over 18 years of expertise in medical billing and coding. With all DME billing guidelines being inducted into our medical billing process, we provide an end to end Revenue Cycle Management (RCM).