DME billing

  • DME Billing Services
    Advantages of outsourcing DME billing

    Advantages of outsourcing DME billing

    Administrations of Durable Medical Equipment (DME) can be a tedious and time-consuming task. In addition to other things, it requires inside and out knowledge of reimbursement rules of Medicare, Medicaid and Commercial Plans, and their admonition. It likewise requires consistent adherence to quality and staying side by side of the considerable number of change events in repayment regulations and coding and documentation prerequisites. When you outsource your medical billing operations, the billing team focuses exclusively on the filing of claims, so there is no pressure on them to treat urgent patients or save lives. They take the workload off your back, freeing up your doctors and team to focus on other matters. There are several advantages of outsourcing DME billing, some of the advantages are listed below: More Control: It is a common misconception that by outsourcing your medical billing services you can lose control over your business processes. In fact, many people feel that they have better control over their medical billing processes and the money involved due to a trained and dedicated outsourced billing staff. This increased control directly ties in with your operational benefits, which stand to benefit from outsourcing. Increased Revenues: Employing staff for billing purposes…

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  • 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 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 this…

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  • DME Billing Services
    Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule Update 2019

    Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule Update 2019

    CMS happen to announce in the year 2019 about Medicare fee schedule rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). The 2019 update factor is 2.3%, although other pricing policies are applied in specific circumstances. The DMEPOS and PEN fee schedule files contain the 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 adjustments. For CY 2019, the following Fee Schedule Adjustment Methodologies apply and fee schedule amounts are based on the area in which the items and services are furnished. Fee Schedule Amounts for Areas within the Contiguous United States To determine the adjusted fee schedule amounts, the average of Single Payment Amounts from CBPs located in eight different regions of the contiguous United States are used to adjust the fee schedule amounts for the states located in each of the eight regions. These Regional SPAs or RSPAs are also subject to a national ceiling 110 percent of the average of the RSPAs for all contiguous states plus the District of Columbia) and a national floor (90% of the average of the…

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  • DME Billing Services
    Durable-Medical-Equipment-DME-Billing-Steps-to-Follow

    Durable Medical Equipment (DME) Billing: Steps to Follow

    Durable Medical Equipment (DME) Billing is different from the other medical billing and coding for the specialties. Unlike the other coders and billers who work on DME need specialized training to deal with different medical situations and equipment that require different types of modifier as requested.  DME billers need a specialized in-depth, specialized knowledge for different types of HCPCS Level 2 codes. Let’s understand the procedures of coding that can be implemented to make the billing process more effective: ICD-9 codes are 3-5 digits in length and speak to the patient’s conclusion CPT restorative charging codes are in fact HCPCS Level I codes. They are 5 digits in length and speak to the methodology performed at the patient’s visit HCPCS codes are in fact HCPCS Level II codes. They incorporate the two numbers and letters and are likewise 5 digits in length. These codes speak to the majority of the provisions or gear utilized in the patient’s consideration. All Durable Medical Equipment is arranged under HCPCS Level II. In that capacity, these are the main codes you will use as a DME biller or coder. Durable equipment must be recommended by a restorative specialist, found therapeutically important, and afterward affirmed…

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  • DME Billing Services
    durable-medical-billing-facilities-need-outsourcing-medical-coding

    Durable Medical Billing (DME) facilities need outsourcing medical coding?

    With over 19 years of experience in Durable Medical Billing (DME) through errors and compliances, we have understated a few paths for DME clients. Every month we add new clients with thousands of dollars are lost in mishandling and unpaid claims in numerous fields of healthcare, including Durable Medical Equipment (DME). Added to this is the multifaceted billing and coding procedures, and the claim requirements of Medicare, Medicaid, and other private insurance companies. To ensure accurate reimbursements and timely revenues, it is imperative to hire an outsourcing agency as it works as a smart solution and completes all the billing and coding requirements; and assists in organizing the entire processes at a fraction of the in-house operating costs. It also makes the in-house billing and coding department’s work a lot easier, less time consuming, and lesser issues related to legalities. Equipment which provides therapeutic benefits to patients who are in need due to certain medical ailments is categorized as DME. It is also known as Home Medical Equipment (HME) and is able to withstand repeated use. Equipment’s considered as DMEs are prosthetic devices, wheelchairs, oxygen equipment, insulin pumps, walkers, hospital beds, power mobility devices, etc. It is known that around…

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  • DME Billing Services
    Analyzing-Home-Medical-Equipment-HME-Future-Beyond-2018

    Analyzing Home Medical Equipment (HME) Future Beyond 2018

    Durable Medical Equipment (DME) suppliers have seen an upward trend in the regulation market. The brief history of Home Medical Equipment (HME) federal rules will provide us with an insight to understand the future of equipment’s for the market. In 2016, with the passage of the 21st Century Cures Act, the suppliers will now receive the adjustments for claims. After which many would consider they had a lengthy delay, the suppliers are beginning to get repayments. The problem with the implementation of Durable Medical Equipment (DME) MACs is that CMS had provided the 24 weeks for completion which concluded in November 2017.  The lengthy delay which happened to complete the implementation process for the quarterly update and the announcement of it by the CMS.  As of data received by CMS, the data reveals that 40.1 percent decrease in the location of DME suppliers nationwide since 2013. The figure gives an indication of How the DME market is currently dealing with instability due to competitive bidding especially in the nationwide expansion of bidding derived rates. The suppliers demand a need for reform to stabilize the market and thus what we might see in the future in term of the equipment market.…

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  • DME Billing Services
    Recent-Policy-Development-for-Durable-Medical-Equipment-Billing

    Recent Policy development for Durable Medical Equipment (DME) Billing

    The US Healthcare industry in its true sense is passing through a transition period, where each medical specialty is waiting on the fence, to find out if there is any further development to their current regime. In those specialties, the Durable Medical Equipment suppliers are also looking for information and updates that would normalize their business, streamline the revenue cycle and are hands-on with their DME billing and coding procedures. The use of durable medical equipment in the home, while not a recent development, was formally recognized by the Congress with the passage of the original Medicare legislation. Since that time the statute has been amended to provide for a more workable, economical, and desirable interface among the administrative, supplier, and user communities. So with regards to renting, purchasing or repairing and maintenance of Durable Medical equipment here are some developments you should keep in mind for perfect reimbursement. Durable medical equipment billing recent policy developments: As a thumb rule, DME requires a prescription to rent or purchase, as applicable, before it is eligible for coverage. Certain items must be rented and may not be purchased (under “Capped Rentals”). Certain other items must be rented prior to being converted to…

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