DME

  • DME Billing
    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
    resolving-the-durable-medical-equipment-billing-dilemma

    Resolving the Durable Medical Equipment Billing Dilemma

    The Durable Medical Equipment (DME) industry is one of the most complex and continually evolving enterprises. While, there are some facilities which have a dedicated in-house accounts department, but most of DME practices today favor to outsource their billing, coding and revenue requirements to professional medical billers and coders. Getting all your charge entries streamlined is one of the most tedious activities one can undertake. Constant adherence to quality is a must. The facility should also stay abreast of all the changes happening in reimbursement regulations and coding. Off-loading the work to an outsourced DME billing company provides a substantial delivery platform that ascertains greater productivity with high quality at a lower cost, and this is where outsourcing steps in. Resolving the Durable Medical Billing Dilemma Choosing an accomplice When looking for an accomplice for DME billing administrations, the facility should conduct a background check as to experience in this field. The outsourcing organization ought to have the capacity to deal with all elements of the income cycle. A solid process has driven philosophy that begins at the offshore destination and remains until the end of the venture, aides to an engaged delivery system. This also helps the suppliers to…

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  • DME Billing
    is-dme-billing-giving-you-nightmares

    Is DME billing giving you nightmares?

    Durable Medical Equipment, as the name implies is medical equipment that is necessary for patients over a period for supportive medical care.DME Billing is a complicated process that involves patient validation, getting prior authorizations for DMEs exceeding the allowed limit if rented or purchased, using correct forms for claims submission (electronic or paper), submit claims to the primary insurer if there is one, ensuring to submit the itemized bill with the claim form, usage of HIPAA compliant billing software, determining the proper billing codes (CPT, HCPCS, ICD-10 CM), resubmitting denied claims with the correct codes. All these can be very exhausting and prone to errors and delay in claim settlements and in some cases, recoupment of claims also happens. Moreover, increased regulatory changes & scrutiny, & the emergence of competitive bidding have impacted reimbursement. Physicians involved in providing DME services are facing the brunt which is affecting operations and profitability and the nightmare of how to deploy resources and where to invest. When a patient gets a prescription for a DME, the provider needs to verify the patients (beneficiary) eligibility and valid coverages under their benefits plan. Most of the cases the DME supplier or the beneficiary’s medical care provider…

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  • DME Billing
    how-to-avoid-medicare-audits-for-your-dme-practice

    How to avoid Medicare Audits for your DME practice?

    Consciously or unconsciously, physicians or their staff may unknowingly be active or passive participants in Medicare fraud, waste, and abuse. Recent figures on the Medicaid program illustrate the scale of the problem. According to the Centers for Medicare & Medicaid Services (CMS), the cost of medical coverage in fiscal year (FY) 2015 was $547.7 billion. The Federal government paid $341.6 billion of that amount. Improper payments were cited as one of the reasons, and it “includes those made for treatments or services that were not covered by program rules, that were not medically necessary, or that were billed for but never provided.” The owner of a Texas durable medical equipment (DME) company, his wife, and other employees admitted to participating in a fraud scheme that involved recruiting beneficiaries to give up their Medicare or Medicaid numbers, misappropriating physicians’ medical identifiers, submitting fraudulent billings, and submitting up to $11 million in false claims, representing about 85 percent of their income. In many instances, the physicians did not see the patients, and beneficiaries never received the items ordered in their names. In 2013, the owner was sentenced to 12 years in prison and ordered to pay $6.1 million in restitution So here’s…

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  • DME Billing
    5-issues-for-dme-practices-to-keep-top-of-mind-in-2017

    5 issues for DME practices to keep top of mind in 2017

    The year 2017 could prove a turning point for the healthcare industry. Slowing limping back into normalcy, most healthcare practices have found some stable ground. This, however, may be rocked again, with a change in political reforms that could even repeal the ACA or popularly called Obamacare act. It would not be difficult to surmise what the main issues for DME practices, especially in the DME practice, could help still maintain equilibrium, despite the coming turbulence. Keep in mind the below 5 issues and your DME practice could sail past the chopping waters: Physician signature: If a claim does not have a physician signature than it would be deemed insufficient. Documentation: Clarity and stringent checks on documentation, both clinically as well as administrative could definitely help strengthen your practice. For instance, if medical documentation displays a different code than the one that was billed, or if services were performed by someone other than the billing provider, then the payment is considered improper. Coding: Know what items can be billed and define the purpose clearly. Overbilling can attract audits which could be a cause for concern. So prepare a checklist of items and keep updated with the CMS and payers rules…

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  • DME Billing
    Overcoming-challenges-faced-by-physicians-prescribing-DME

    Overcoming challenges faced by physicians prescribing DME (durable medical equipment )

    It is well known to physicians that durable medical equipment (DME) services are ancillary to the primary clinical purpose. However, most physicians are also aware that when prescribing DME, they may not get the reimbursement due to them as their admissibility is subject to certain conditions. There may be a number of reasons why physicians who prescribe DME to their patients, their claims are often denied or rejected. The reasons could be due to: Deemed medically unnecessary They did not have the proper credentials and thus deemed Uncertified by Medicare/Medicaid/private health insurers They have claimed beyond the permissible reimbursement level Have not met certain regulations & compliances set down  by the Healthcare Common Procedure Coding System (HCPCS) One of the major setbacks faced by physicians is the lack of drive to back their recommendation with sufficient proof of the service rendered being medical necessary. And this is due to bad processes in verification & documentation, which leads to low resubmission for claims and thus losing a lot of reimbursements affecting their Revenue Cycle Management (RCM) process. Moreover, in 2015, Medicare had a 40 percent improper payment rate for durable medical equipment, prosthetics, orthotics, and supplies, resulting in $3.2 billion losses.…

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