DME billing and coding service

  • DME Billing Services
    Know your DME HCPCS Codes

    Know your DME HCPCS Codes

    In DME medical billing, your DME coders require correct HCPCS codes along with correct modifiers that are used for providing more details about the equipment. If your medical coders are unable to use modifiers or not using them in the correct manner, then the claims may get denied from the insurance company. Some common DME modifiers which include RR- rental, UE- purchase of used equipment, and NU- purchase of new equipment. When a laboratory demand, request for DME is being filled, medical coders will be needed ICD-10 codes for a patient’s diagnosis. To use an appropriate HCPCS code for the DME item, many HCPCS codes need a modifier. Modifiers are used to provide more details about the DME item. e.g. The modifier might indicate HMSA that an item is new, rented on a capped basis, or rented. For capped rentals, modifiers differentiate which month’s rental is being billed. If your billers use these modifiers incorrectly then the claim will be rejected. To speed up this process of your claims, show the first-month rental by adding the appropriate modifier code and bill your claims in successive order. HCPCS Code Range: E0100-E8002: Durable Medical Equipment E0100-E0159: Walking Aids and Attachments E0160-E0162: Sitz Bath/Equipment…

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  • DME Billing Services
    CMS announcement for durable medical equipment suppliers

    CMS announcement for durable medical equipment suppliers

    The Centers for Medicare & Medicaid Services (CMS) announced updated guidance regarding several emergency waivers related to Medicare and Medicaid policies and regulatory updates during this pandemic for durable medical equipment suppliers. The CMS very likely will continue to announce supplemental guidance on the blanket waivers. Here we have a detailed summary of the relevant waivers that will affect durable medical equipment suppliers, prosthetics, orthotics, and supplies (DME) and are projected to prepare the American healthcare system with maximum flexibility to respond to the public health emergency.  These temporary changes will remain in effect across the U.S. healthcare system for the duration of the pandemic emergency declaration. By enacting these waivers, CMS hopes to “put patients over paperwork” to give some relief from vast documentation work, reporting, and audit requirements. Now providers and regulators can focus on providing required care to Medicare and Medicaid beneficiaries impacted by coronavirus. Prior Authorization CMS waiving certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to release the administrative load of compliances during public health emergencies. In normal conditions, DME suppliers are required to undergo a prior authorization process to make sure that applicable coverage, payment, and medical coding rules are met before…

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  • DME Billing Services
    DME Prior Authorization Programs - GAO

    DME Prior Authorization Programs – GAO

    According to the analysis of GAO, CMS’s prior authorization programs for durable medical equipment (DME) created an estimated $1.9 billion in Medicare savings. CMS’s prior authorization programs for durable medical equipment (DME) and mobility devices have controlled unnecessary spending, according to a new Government Accountability Office (GAO) report. This was created between $1.1 and $1.9 billion in Medicare savings from 2012 to 2017. Prior authorization is a payment approach used by private insurers that generally requires health care providers and suppliers to first demonstrate compliance with coverage and payment rules before certain items or services are provided to patients, rather than after the items or services have been provided. This approach may be used to reduce expenditures, unnecessary utilization, and improper payments. The Centers for Medicare & Medicaid Services (CMS) has begun using prior authorization in Medicare through a series of fixed-length demonstrations designed to measure their effectiveness and one permanent program. According to GAO’s analyses, expenditures decreased for items and services subject to a demonstration. GAO’s analyses of actual expenditures and estimated expenditures in the absence of the demonstrations found that estimated savings from all demonstrations through March 2017 could be as high as about $1.1 to $1.9 billion.…

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  • DME Billing Services
    CY 2020 Update for Durable Medical Equipment

    CY 2020 Update for Durable Medical Equipment

    CMS has revised previous updates of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule on January 3, 2020, to reflect an updated Change request (CR) that corrected the CY 2020 maintenance and servicing fee for certain oxygen equipment to $73.02 in the CR’ s business requirement 11570.9. The transmittal number, CR release date, and link to the transmittal also changed. All other information remains the same. These changes are intended for providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items or services paid under the DMEPOS fee schedule provided to Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) updates the DMEPOS fee schedule on an annual basis in accordance with statute and regulations. For CY 2020, the following applicable Fee Schedule Adjustment Methodologies and fee schedule amounts reflect the area in which the items and services are furnished. Fee Schedule Amounts for Areas within the Contiguous United States Claims with DOS Jan 1, 2019 – Dec 31, 2020 The adjusted fee schedule amounts for items furnished in non-competitively bid rural areas are a blend of 50 percent of the adjusted fee schedule amount and…

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  • DME Billing Services
    Streamline your DME Billing with MBC

    Streamline your DME Billing with MBC

    All the healthcare providers are searching for a streamlined DME billing operation team that may handle their DME billing process without much hassle. According to MarketWatch, the worldwide marketplace for Durable Medical Equipment (DME) is predicted to achieve up to USD 246.6 billion by the year 2026. This rise is predicted because of the advantages that DME products like a wheelchair, nebulizer, canes, crutches, walkers, etc. wear peoples. except for making patient’s life easy, the DME products also help these patients live a life without much pain making them independent. Besides the above benefits, technological advancement within the DME medical equipment is additionally other reason for the increase of the DME market and in fact, the rising geriatric population. As old people are more prone to chronic diseases, requiring extended care that involves more of the DME products for leaving a simple life. As per the report, the worldwide DME market is fragmented supported the tip user, region, and device type. With reference to device type, the market is further divided into therapeutic and monitoring devices, medical furniture and loo safety devices, and private mobility devices. Sub-segments of the therapeutic and monitoring devices market include nebulizers, infusion pumps, oxygen equipment,…

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  • DME Billing Services
    Prior Authorization Process for DME during COVID-19 - Provider Burden Relief FAQs

    Prior Authorization Process for DME during COVID-19 – Provider Burden Relief FAQs

    The importance of medical review activities to CMS’ program integrity efforts, CMS will stop exercising enforcement discretion for the Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items beginning on August 3, 2020, regardless of the status of the public health emergency. Is CMS suspending most Medicare Fee-For-Service (FFS) medical review during the Public Health Emergency (PHE) for the COVID-19 pandemic? Yes, CMS had suspended most Medicare Fee-For-Service medical review during the COVID-19 period. This includes: Pre-payment medical review conducted by MACs Post-Payment reviews conducted by MACs Supplemental Medical Review Contractor (SMRC) Reviews Recovery Audit Contractor (RAC) No additional documentation request will be placed during the COVID-19 emergency period. Targeted probe and Educate reviews that are in process will be suspended and claims will be paid. All current post-payment MAC, SMRC, and RAC reviews will be suspended and released from review. This suspension of review activity is for the duration of the public emergency period only. However, CMS reserve the right to conduct medical review during or after a pandemic situation if there is an indication of potential fraud. Is CMS waiving signature requirements on proof of delivery slips in response to the COVID-19 pandemic,…

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  • DME Billing Services
    DME Supplies for Children with Disabilities

    DME Supplies for Children with Disabilities

    There might be a need for medical equipment or supplies for children with disabilities or having special health care needs. Once you identify your child’s needs then, you will be thinking about the different options as well as the ways to pay for durable medical equipment. However, insurance is one of the solutions for your problem as both Medicaid and other health insurance which is often cover some or all of the costs for these medically necessary items. Following tips are important to walk through for insurance system including Medicaid: Durable Medical Equipment (DME) and Supplies for Children DME is a kind of medical equipment, which is generally used for a longer period of time. Majority of the durable medical equipment anticipated to last for more than three years. Some of the DME’s are as follows: Hospital beds Hearing aids An augmentative communication device especially for children who are unable to speak or possessing some sort of speaking disability Manual and power wheelchairs Oxygen equipment Many children who utilize DME also need medical supplies. These supplies are utilized for a short period (sometimes utilized only once) and then disposed of. Many of these supplies needed on daily as well as…

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