How to Successfully Navigate the DME Billing World

Durable Medical Equipment (DME) billing is heavily inspected, and the payor policies are ever-changing. Creating, implementing, and maintaining an effective DME billing environment is critical to ensure minimal claim denials and streamlined revenue cycles.

If you need additional support or your DME billing process is too time-consuming, outsourcing to a trusted DME billing company can help with your medical billing needs.

What You Need to Know About an Effective DME Billing Process 

Maintaining an effective DME billing process is crucial to ensure timely paid claims.

Below are some steps you should include as part of your DME billing process. 

  • Audit yourself and look for any potential document errors
  • Constantly review your billing process and make improvements 
  • Have a system in place throughout the entire process from intake to payment 
  • Implement quality control process for all documents received 
  • Make sure your billing coders are well trained 
  • Properly train your staff on your DME billing process 
  • Regularly review your claims denial rates and reasons 
  • Review unpaid claims daily 
  • Stay up-to-date on DME billing and coding regulations 
  • Take advantage of DME billing technology (when it’s necessary)

How Can Medbill Help?

The Medbill team has a Document Review (DR) Process that ensures only clean claims are submitted. Our DR Process works with our audit ready review service so you’re prepared for future audits.

How is it different from others?

The Medbill review differs from other companies because it’s so much more than a checklist. We provide you with a thorough analysis, and we become your support system for you. We work collaboratively with your team to ensure claims are paid on time and are audit ready.

3 Keys to Success for Document Review 

The Medbill DR Process helps you implement effective billing procedures while educating you and your staff on the constantly changing payor policies. 

Below are the three keys to success for the Medbill review process. 

#1 Payor Guidelines and Billing Procedures 

The Medbill team follows specific payer guidelines for medical necessity and billing procedures. The steps we take includes:

  • Reviewing your physical documents 
  • Checking your billing setup 
  • Performing a medical necessity review of documentation based on equipment dispensed
    • This is performed post dispensing to ensure a clean order is billed 

#2 We Act as a Human Firewall 

With the help of our reviewer team, we act as a “human firewall” for clean claims while we stay current on all guideline changes. 

#3 Clean Claim Process 

We help you put procedures in place that ensure only clean claims are submitted. Once your billing team compiles all the documentation, the Medbill team does a final check. 

Some of the items we look for include: 

  • Proof of delivery
  • Physician order (SWO, dispensing order, script- as needed by payor)
  • Medical necessity documentation
  • Face to Face encounter/office visit note (as needed by payor)
  • Clean billing setup
    • Correct modifiers
    • Frequency received is allowed (per payor)
    • CMN and authorization logged
    • Applicable diagnosis as Primary
    • Item Claim Notes or span dates
  • We can look for additional items based on your specific needs. 

Afterward, if anything requires correction, we will provide you feedback on what is needed. Our review ensures that all potential errors are resolved before the order is billed. 

Medbill’s Commitment to You

The Medbill team is committed to providing quality, superior service to help ensure our customers are continuously audit ready. We become a support system for your billing team to ensure claims are paid on time and audit ready.

Contact us today so we can help support your team and business goals!