A DME billing specialist is a person who submits and audits claims within the Durable Medical Equipment (DME) industry. The billing specialist communicates with patients, medical professionals, and insurance companies regarding claims.

A DME billing specialist’s goal is to ensure all submitted claims are accurate and contain all the required paperwork to reduce the number of rejections. A qualified and experienced specialist can significantly improve collection rates for DME providers.

DME Billing Specialist Responsibilities

A DME specialist has many responsibilities, depending on their specific job and its requirements.

Some of their responsibilities can include:

Ensure compliance with payors guidelines
Check and correct HCPCS codes
Submit and follow up on claims
Post account charges and payments
Process claims denials and insurance appeals
AR follow up
Handle patient collection calls
Use various billing software systems
Perform medical billing functions via Electronic Medical Record (EMR)
Resolve unpaid claims and denials
Monitor accounts for non-payments, delayed payments, and other irregularities

Submits Clean Claims the First Time

When submitting claims, the DME billing specialists guarantee the claim includes the proper documentation, correct patient information, and appropriate coding. This is to ensure clean claims are submitted and paid on time.

DME Billing Specialist Qualifications

To become a qualified DME billing specialist must meet specific requirements.

Have a high school diploma
Pass the DME certification exam
Have a verifiable minimum of 500 hours of documented experience at a DME facility
Meet continuing education and annual renewal requirements to maintain certification

For more information on the DME certification exam, click here.

The DME Certification Exam

The DME certification exam certifies and accredits the DME billing specialist’s ability to perform the necessary tasks the job requires and ensures safe practice environments.

The DME exam topics focus on understanding the DME industry with topics on:

The intake process
Product selection
Dispensing and setup
Documentation
Billing
Compliance
Performance management

Working with trained and certified DME specialists guarantees you’ll have professionalism and billing accuracy throughout the company.

Is Outsourcing Right for You?

DME billing companies, like Medbill, hire billing specialists to help DME providers increase their collection rates and improve their claims submission. Outsourcing your DME billing needs to an has its benefits, including:

Access to seasoned, trained professionals
A team of experts whose only job is to improve your DME billing
Keeps you current on the constant changing payor policies
Access to a billing team that have years of experience that understand the US healthcare system

Questions to Ask Yourself

If you’re not sure if outsourcing is right for you, consider the following questions to help determine if you need to outsource.

Do you want more control and better monitoring of your billing process and data?
Do you want to increase your collection rate?
Do you want to minimize your claims denial rate?
Do you want improved billing operational efficiency?
Do you want to improve the patient experience with your company?
Increase your and your staff’s time to focus on other revenue-generating activities?

Our Commitment to You

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