As a physician, you feel responsible both towards your patient and staff to verify that all is going well. So too, when you make the decision to outsource your DME billing services – you need to constantly track and check all aspects of the services provided by the DME provider. The reason being- you need to meet compliance and also make strategic decisions from time to time, given the changing healthcare rules & regulations.
Wondering what are the questions you need to ask your DME billing service provider? As a physician, you need to remember that the most important component of your practice is to keep the revenues flowing. For this, to work you need to ensure that not just the coding and billing is being done by certified billers & coders but also are they meeting the compliance when processing for claims.
The most crucial question however you should be asking your DME service providers is, “Are the DME claims in accordance with Healthcare Common Procedural Coding System (HCPCS) Level II coding guidelines and national and local coverage determinations (NCDs and LCDs)?”
Further, when a claim is received, Medicare determines if the ordering/referring provider is required for the billed service. If the provider is not on the claim, Medicare does not pay. But, if and when the ordering/referring provider is on the claim, Medicare will verify that the ordering/referring provider is in Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and eligible to order and refer.
Physicians need to remember that when engaging in DME billing they need to ensure that providers may only bill for the actual number of medical necessary units dispensed or delivered to a patient, regardless of the number of units allowed by policy and/or prior authorization.
Another caution that physicians need to undertake is that orders are required for any DME equipment to be covered under Medicare. To bill Medicare for DME, the ordering physician must be a Medicare-enrolled physician.
Ensuring that your DME service provider has taken all the necessary precautions as a pre-requisite, your other queries can then center on the success rates of their A/R collections and claim denial management process. This is very crucial to the RCM process and the profitability of your practice. Also, how often do they engage with you in terms of updating you about documentation requirements and coverage guidelines, is essential to note?
Another thing to ensure is that most of their processes should be electronic from eligibility verification to remittances, especially in today’s technology savvy world.
And last but not least, never assume that they will do everything or that everything is included in the DME services you requested of your provider. Always ask up front and be sure you know if there are services that they don’t offer.
The above queries are just a guide to help you know that you are on the right track in your decision when selecting a DME service provider. Evaluate your options with caution and take your time. Cover compliance asking the necessary certifications, operation & financial processes, and success rates and follow-up procedures for errors – and with this you have your bases covered and your checklist will determine the next step.