As a DME provider or supplier, you’re responsible for billing claims to Medicare when you supply patients with their DME items. This process might feel like an overwhelming task if you’re new, especially if you’re not an experienced biller and coder. The good news is that this article will provide you with some helpful tips on how to bill Medicare for DME items!
5 Tips on How to Bill Medicare for DME Supplies
The advice and tips below will help you get started with billing Medicare for DME supplies. It’s important that you always follow the industry’s latest rules and regulations to ensure you have the most accurate information before submitting the claims. Review the Centers for Medicare and Medicaid Services (CMS) website to monitor any recent changes.
#1 Show Proof of “Reasonable and Necessary” Supplies
Every document you submit with a claim needs to show medical necessity. As the provider, you’re responsible for providing Medicare with proof that the item is medically necessary for the patient.
Here are a few documents you can include to help show that the DME is “reasonable and necessary.”
- Hospital and doctor medical records
- Order prescriptions from a medical professional
- Certificate of Medical Necessity signed by the medical professional and DME provider
- Progress notes that is signed and dated
#2 Review Documents to Ensure Legibility
All documents must be legible, whether you’re submitting an electronic or paper claim. If the information can’t be clearly understood and it doesn’t include a physician’s signature, then Medicare won’t accept it as valid. Make sure to review the documents and request new copies of the illegible content.
#3 Be Clear and Concise
You shouldn’t submit information just “hoping” it fulfills the medical necessity requirements. Everything you submit must make sense and be clear, concise, and to the point to reflect the patient’s condition.
#4 Use Up-to-Date Codes and Modifiers
Before submitting the claim for payment, you need to confirm that the equipment shows the correct codes and includes the appropriate modifiers. Check to ensure that:
- HCPCS Level II codes match the ordered DME
- Modifiers include all the necessary information about the item
#5 Submit Claim Documents
When you’re ready to submit the DME claim to Medicare, you’ll use the CMS-1500 form (also known as HCFA 1500). Claims should be submitted electronically to Medicare. CEDI is the Medicare contractor for submitting electronic claims to Medicare. If you are considered a small supplier, you may have exceptions to submitting electronic claims. Contact CEDI for more information.
Learn more about HCFA 1500 ordering guidelines and form instructions.
Billing Medicare Next Steps
Learning how to bill Medicare for DME is a detailed and involved process. The tips above help guide you as you navigate the submission process. Still, you’ll need to monitor industry changes to stay current on all your submissions. Learn more about the Medicare DME Documentation Requirements for Providers here.
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