Submitting durable medical equipment (DME) claims requires attention to detail and focus. Then due to the ongoing industry changes, DME billers and coders need to maintain compliance and meet industry standards constantly. Here is a quick overview of how to bill DME claims to help increase your claim approvals, resulting in faster payments.
4 Steps on How to Bill DME Claims
The following steps will go through the typical DME billing process once a patient places an order to claim submission.
Step 1 Verify Insurance
- New Patients – Contact their insurance carrier to confirm all the patient’s information is correct.
- Current Patients – Reconfirm insurance information once a patient places their order to ensure details haven’t changed.
- New Calendar Year – At the start of the calendar year, many insurance deductibles start over, and some details change. Confirm all information with the patient and contact their insurance carrier.
Step 2 Gather All Necessary Documents
- Order Prescription – Proves that a medical professional prescribed the patient with the equipment as part of their treatment plan.
- Certificate of Medical Necessity – Verifies that the item will help to treat or prevent potential problems from occurring. It must be signed by the medical professional and DME provider.
- Prior Authorization from Medicare – Shows proof to the Centers for Medicare & Medicaid Services (CMS) that the DME is medically necessary for the patient.
- Proof of Delivery – Verified that the equipment was delivered to the patient, you’ll need to include either a signed delivery slip or photo of the item.
Step 3 Process the DME Invoice with Correct HCPCS Level II Codes
During this step, as you process the invoice, it’s essential to confirm that all the equipment is coded correctly and includes the appropriate modifiers.
- HCPCS Level II codes correspond to the specific DME product.
- Modifiers include detailed information about the equipment.
Step 4 Bill DME Claim
When you’re ready to submit the claim, you’ll need to use the CMS-1500 form (also known as HCFA 1500). This form will allow you to submit claims from government insurance plans, including Medicare and Medicaid. Learn more about the DME Claim Form HCFA 1500.
Please Note: If you submit claims to a private insurance payer, you may have the option to send it directly to them.
Learn More About Billing DME Claims
Many reliable resources are available to help you learn more about how to bill DME claims. Below are a few articles and websites that will help you with submitting claims.
- How to Bill DME Items – This article explains HCPCS codes and modifiers and how a four-step billing and coding process works.
- DME Documentation Requirements for DME Providers – This article provides information on the various documentation requirements when billing DME.
- Medicare DME Documentation Requirements for Providers – This article includes information about Medicare DME billing compliance.
- CMS’s DME Center – This website provides valuable information on industry updates and regulations.
- 277CA Edit Lookup Tool – This website explains the edit codes that follow a claim rejection.
- NPI Registry – This free system allows you to search for NPPES medical professionals and confirm that their files contain correct information.
Save Time & Resources with Medbill’s Assistance
Medbill is a DME billing company that can help with your DME needs. Our team of billing experts is 100% U.S.-based. They can help you navigate the constantly involving DME industry by reducing your DSO and increasing your claim approvals. Contact us to learn more!