Durable Medical Equipment (DME) billing is a complex industry, which leads to many people asking the question, what is DME billing? DME billing is the process of submitting then receiving reimbursement for the purchase or rental of DME items from an insurance company.
To ensure you receive proper payment as a DME provider and DME supplier, you will need to implement, maintain, and educate your staff on appropriate billing protocols. Additionally, it’s vital to stay up to date on industry guidelines and compliance to ensure you submit clean claims and receive timely payments.
The DME Billing Industry
The DME billing industry has two main components, including:
- DME billing allows a patient to rent or purchase equipment.
- DME billing requires HCPCS (Healthcare Common Procedure Coding System) codes.
Rentals vs. Purchases
DME billing is also different from others because of its reimbursements process. When submitting claims, DME billers and coders need to know the exact coding procedure to differentiate between an item being purchased or rented so the insurance company can reimburse the correct amount.
If you rent a DME item, the billers and coders need to specify the exact dates during the equipment rental period. Those dates need to be listed separately on the claim for the insurance company to pay the correct amounts.
DME billers and coders must classify all DME items under HCPCS Level II, making it essential that anyone working in the billing industry will need to have in-depth knowledge and understanding of HCPCS Level II codes. When submitting insurance claims, HCPCS helps to identify the billed item or service provided. For instance, HCPCS code E0607 represents a home blood glucose monitor.
CMS and the DME Billing Industry
The need for medical equipment in the home is on the rise, mainly because of the increasing aging population. The Centers for Medicare & Medicaid Services (CMS) is part of the U.S. Department of Health and Human Services. CMS oversees many government programs, including Medicare and Medicaid.
Every year CMS releases updates on Medicare and Medicaid information that impact how to bill DME. Additionally, CMS works to eliminate fraud and abuse within the Medicare and Medicaid system through various claims audits.
It’s important to stay current on all updates from CMS regarding DME. You can review the CMS DME Center website page for updates, press releases, and more.
How to know if Medicare will pay for DME?
The Medicare insurance coverage contains multiple parts. To make sure you and your customer understand if Medicare will cover the DME equipment, read our two news articles on the topic.
Additionally, read our news article on “Becoming a DME Supplier for Medicare” if you’re interested in becoming one.
Discover More About Medbill
Medbill is a team of highly skilled and trained DME billers with a 100% U.S.-based staff. At Medbill, we offer DME billing services, audit assist services, individualized support, and more to meet your needs.
Contact the Medbill team to learn how we can help you!