How DME & Medical Billing Differs | DME Billing for Dummies

If you’re new to the Durable Medical Equipment (DME) billing industry and want to learn some of the initial steps to the DME billing process, this article will provide you with a simple introduction. First, it’s essential that you know that DME billing is a complex and lengthy process. Learning to bill DME items requires more than a “DME Billing for Dummies” book, which is why a billing specialist must meet specific requirements to become qualified. 

DME Billing for Dummies – What You Should Know About This Popular Book

There’s a popular book sold online that teaches the reader about medical billing and coding. It’s so popular that many users looking for information on DME billing will come across this book and hope it will answer their questions. Unfortunately, this book isn’t the best resource for learning about DME billing. This book mainly focuses on medical billing, which has significantly different components from DME billing.

If you want an introduction to the DME process, read our article on A Simplified Explanation on How to Bill DME Items.

DME vs. Medical Billing and Coding 

The most significant difference between DME and medical billing is that DME billing requires a more in-depth knowledge of various medical situations and specialized DME items than traditional medical billing and coding requires. Below are four key differentiators between the two types of billing. 

DME Billing: Uses various types of HCPCS Level II codes

Medical Billing: Uses HCPCS Level I codes

 

DME Billing: Requires the use of modifiers and will determine if a claim is approved or denied 

Medical Billing: Modifiers are usually optional since they don’t directly impact if a claim is approved

 

DME Billing: Reimbursement is a complex and lengthy process; one small error could result in a denied claim 

Medical Billing: Reimbursement is typically based on the revenue codes or the procedure codes 

 

DME Billing: Different types of coding and requirements for renting or owning equipment. Codes are specifically designated to items, not procedures.

Medical Billing: Most of the coding involves services/procedures performed and not equipment 

3 Common DME Mistakes 

Due to its complex nature, DME billing can take time to understand fully. Here are some common mistakes that can occur and tips on how to avoid them.

Common Mistake: Submitting Incorrect Documentation 

Helpful Tip: Always confirm with the insurance company if you’re unsure of the specific documents needed before dispensing the order to the patient.

 

Common Mistake: Not Showing Medical Necessity 

Helpful Tip: The patient’s record must always show medical necessity. Stay current on your Local Coverage Determinations (LCDs) and medical policies which will help to keep you informed on what you need to include for medical necessity proof.

 

Common Mistake: No or Inefficient Billing Processes in Place 

Helpful Tip: The DME industry is constantly changing; having a billing system in place will allow you to adjust quickly and efficiently when a guideline changes.

Learn if Outsourcing is the Right Option for You

Medbill is a reputable DME billing company that helps DME providers better understand billing requirements and processes. Our article on How to Determine if DME Billing Services are Right for You will help you learn about the value billing services offer.

Contact us to learn how we can help with your billing needs and increase your DSO!