DME billing service

  • DME Billing Services
    Specialization consideration for DME suppliers in medical billing and coding

    Specialization consideration for DME suppliers in medical billing and coding

    Durable medical equipment billing is the process by which insurance companies are charged for the services provided to their clients. And in order to achieve the complete reimbursement dollars billing codes that represent different aspects of the DME process are implemented. The characters the biller enters relate to different aspects of a diagnosis or procedure and allow the information to be uploaded for billing without having to manually define either diagnosis or procedure. This allows the process to be implemented faster without having to describe everything in detail. When we talk about specialization consideration in DME suppliers’ one specialty that often crosses the supplier’s path is Orthopedics. Orthopedic facilities often provide patients with supplies, such as casts and canes, which are integral to patients’ treatment plans. What DME supplies can be used for an orthopedic treatment and how to charge for them? The Current Terminology Codes (CPT) published in the American Medical Association’s are used for professional DME coding. These codes are frequently known as Level I of the Healthcare Common Procedure Coding System (HCPCS). DME suppliers are categorized as Level II HCPCS codes and are recognizable by their alpha-numeric structure. Just like CPT codes, Level II HCPCS codes are…

    Read More »
  • DME Billing Services
    Critical factors to consider before you outsource DME billing and coding

    Critical factors to consider before you outsource DME billing and coding

    Durable Medical Equipment (DME) as a healthcare industry field is different from other specialties and so is its medical billing and coding requirements. You need an in-depth and specialized knowledge of all the updated HCPCS Level II codes as DME claims are classified under HCPCS Level II. And as to speak about DME suppliers, the complex nature of reimbursement is another challenge they constantly face. Since patients can rent expensive equipment rather than purchase, DME billers and coders must be conscious of exactly how to code claims and when to send them for getting the precise reimbursement amounts. What this means is that the code should lay down the equipment was rented and not purchased. The rental period should be recorded separately on the claim so that the insurance company will pay a small reimbursement for each of those days. Outsourcing your DME medical billing tasks facilitates a smart solution for your hospital billing requirements, assisting you to organize the entire billing and collection process at a portion of your current operating costs. If you want to make the in-house workload a bit lighter, it’s a great idea to consider outsourcing your DME billing. Here are some important ways by…

    Read More »
  • DME Billing Services
    Updated DMEPOS Codes Fee Schedule 2019

    Updated DMEPOS Codes Fee Schedule 2019

    The Centers for Medicare & Medicaid Services (CMS) updates the DMEPOS Codes Fee Schedule on an annual basis in accordance with statutes and regulations. Payment on a fee schedule basis is required for certain Durable Medical Equipment (DME), prosthetic devices, orthotics, prosthetics, and surgical dressings by Section1834 (a), (h), and (i) of the Social Security Act (the Act). Additionally, payment on a fee schedule basis is a regulatory requirement at 42 Code of Federal Regulation (CFR) Section 414.102 for Parenteral and Enteral Nutrition (PEN), splints, casts, and Intraocular Lenses (IOLs) inserted in a physician’s office. The DMEPOS and PEN fee schedule files contain Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the adjusted fee schedule amounts under Section 1834(a)(1)(F) as well as codes that are not subject to the fee schedule Competitive Bidding Program (CBP) adjustments. New Codes Added New DMEPOS codes added to the HCPCS file, effective January 1, 2019, where applicable, are A4563, A5514, A6460, A6461, B4105, E0447, E0467, L8608, L8698, L8701, L8702, V5171, V5172, V5181, V5211, V5212, V5213, V5214, V5215, and V5221. The new codes are not to be used for billing purposes until they are effective on January 1, 2019. As part of…

    Read More »
  • DME Billing Services
    Outsourcing-(DME)-Medical-Billing-Services

    Tips for Outsourcing (DME) Durable Medical Billing Services

    Durable Medical Equipment is a profitable industry that 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 a more transparent payment model we are here to weigh your options. Before we dive into Durable Medical Billing Services we need to understand: The Guidelines 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 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…

    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 the 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…

    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
    lacking-in-ar-management-can-harm-your-durable-medical-equipment-revenue

    Lacking in AR Management can Harm Your Durable Medical Equipment Revenue

    Accounts Receivable (AR) is a key parameter in the financial division of every healthcare facility. It is defined as the money owed by the healthcare facility for the services rendered to the patients. Being a vital aspect of the revenue cycle management, the cash flow of the healthcare facility is directly proportional to the managing of AR. AR is calculated as: Total charges for last 6 months/number of days in last 6 months = average daily charges Total AR / average daily charges = days in AR AR can be duly managed if the medical billing and coding professionals are knowledgeable about coding parameters, insurance rules, timely claim filing and follow up (of regular and rejected claims). Usually, the healthcare facility is paid by the insurance and the patient. A delay in either of these negatively affects revenues and leaves a great deal on the table. Hence, it is imperative to monitor the AR on a continuous basis. And this must be done by professionals who know the healthcare practices’ contract terms claims adjudication. The professionals managing AR must also know how to calculate copays which the patients are required to pay. Other practices to be followed are: prior authorization,…

    Read More »