What is HME Billing?

Due to its complex nature, many people ask the question, “what is HME billing?” Home Medical Equipment, or HME, billing is when claims are submitted to an insurance company for reimbursement after purchasing or renting HME or durable medical equipment (DME) items. 

The HME billing industry changes and evolves every year. To ensure timely payments and clean claims submissions, many providers and suppliers look at other billing options to save on time, resources, and costs. 

The HME Billing Industry 

To guarantee HME and DME items reimbursement, you’ll need to meet industry guidelines every time a claim is submitted. HME providers or suppliers will need to follow specific procedures to ensure proper payment is received, including: 

  • Implementing, maintaining, and educating staff on billing protocols
  • Staying up to date on industry guidelines
  • Making sure claims meet industry compliance 

HME Rentals vs. Purchases 

During the reimbursement process, billers and coders must use various codes to differentiate between an HME rental or purchase. A coding mistake can lead to denied claims that will need to be resubmitted and extend the reimbursement period. 

HCPCS Codes for HME 

All HME items need to be classified using HCPCS Level II codes. An HCPCS code describes the item being or service being billed. For example, HCPCS code E0607 represents a home blood glucose monitor. To correctly bill items, industry billers and coders need to have in-depth knowledge and understanding of HCPCS Level II codes since they differ from HCPCS codes.

The Centers for Medicare & Medicaid Services (CMS)

Medicare and Medicaid are government programs that help cover the costs for HME and DME items for patients, and the CMS oversees those programs. Every year updates and changes are made to the programs that impact how those items are billed and paid. 

The CMS DMEPOS Fee Schedule Adjustment Announcement CMS DME Center website contains updates, press releases, and additional information to help you stay current on those changes.

What is HME Billing Solutions?

Since it requires significant resources to ensure clean claims, many HME companies consider outsourcing their HME billing services. HME billing solutions provide many services including, 

  • Accounts receivables collections
  • Claims management 
    • Cash posting
    • Price table configuration 
    • Claims submission
    • Revenue cycle management 
    • Claims status
  • Document review

Finding a trusted HME billing company will require some research on your end. You’ll need to gather information on the prospective company, their success rate, and customer testimonials, all to make an educated choice before selecting the best company for you. 

Outsourcing Benefits 

If you’re not sure outsourcing is right for you, here are some benefits it provides to HME providers and suppliers. 

  • You can focus on additional business responsibilities 
  • It’s an extension of your billing department 
  • Improves collection rates
  • Shortens your DSO (day sales outstanding) 
  • Reduces operational costs
  • Educates your staff on billing policies and changes

A Trusted, HME Billing Company 

As a 100% US-based staff, Medbill provides HME billing services specific to your business needs. Our team will guide you through the different processes to help meet your goals, including lower denials and improved cash flow.

Contact a team member to learn more.