Durable Medical Equipment (DME) payor medical policies and DME billing guidelines will change over time (some product lines change more often than others). Building and maintaining a process for all referrals will help you stay current on all changes, and will save you time and effort. The Centers for Medicare and Medicaid Services (CMS) website is a helpful way to stay up to date on all Medicare and Medicaid DME guidelines.
3 Helpful Tips to Follow for Billing Guidelines
DME billing requires accurate, top-level coding to ensure correct claims submission, especially when changes or updates occur. Here are three tips to help create an efficient billing process so that you will be ready when guidelines change.
#1 Provide Correct Documentation
Accurate claims submission needs correct coding and proper documentation. This includes confirming with insurance companies if specific documents are required before dispensing an order. These extra steps will save you time and effort to prevent denied claims if an insurance company has changed its policies.
HCPCS Level II Code Ending in 99
When an HCPCS code ends in” 99,” you will need to provide the required support documents when you submit the claim. If the documents aren’t with the paperwork, the insurance company will suspend the claim until the documents are received and reviewed (results in delayed claim payments).
#2 Establish Medical Necessity
For a patient to receive a DME item, their medical record must show it’s a medical necessity to assist in the treatment of their diagnosed medical condition. Local Coverage Determinations (LCDs) are policies that can address the need for DME items. Understanding the specific LCDs for your area will ensure correct claims reimbursements.
#3 Streamline Your Billing Services
Putting a billing system in place will help you streamline the claims processes. So when there’s a guideline change, an efficient billing process will allow you to make the needed adjustment and continue submitting claims.
Identify steps in the process that can be tracked and monitored. By identifying these areas, trends and issues can be uncovered quickly, and growth potential can be realized.
5 Tips to Stay Current DME Market Trends
Here are five ways to stay current on DME billing updates and changes.
1. Industry Publications
Subscribe to online/print trade journals and magazines and take a few minutes each week to read one article about DME news.
2. Share Industry Articles
Share any interesting articles or news about the DME industry. Even consider creating an online source where employees can share these articles.
3. Set Up Email Notifications
Create RSS feeds that are emailed to you so you can follow essential topics related to DME.
4. Follow CMS for Updates
Visit the DME Equipment Center on CMS.gov for updates on current and new policy changes.
5. Follow Medbill’s News Section
Subscribe to Medbill’s blog on the “News” section of our website, medbill.com. We stay current on the latest DME industry news.
Additional Resources for DME Billing Guidelines
If you would like to read additional information on DME billing guidelines, view the articles below.
- 2021 Medicare Guidelines Update on SWO and Frequency
- Does Medicare Pay for DME in a Nursing Home?
- Does Medicare Cover DME in a Long Term Care Facility?
Medbill Can Keep You Updated on DME Billing Guidelines
Medbill is a trusted DME Billing Company. The Medbill team helps their customers stay current and better understand DME billing requirements.
Find out how Medbill can help you stay current on the ever-changing DME industry by contacting us.