Are you new to DME billing or maybe you’re familiar with the billing process but trying to learn why your denial rate is high? We’re here to help. This online DME billing manual article will help you familiarize yourself with the billing process and provide additional resources to have a profitable and thriving DME business.
DME Billing Specialists: What You Should Know
A quick online search will tell you that DME billing is a complex (and heavily regulated) industry for any business owner. Although it’s good to have a knowledgeable understanding of what’s involved, it’s still best to hire skilled and qualified staff for your billing department.
Online DME Billing Manual: The Billing Process
This online DME billing manual article will provide you with a three-step introduction to the DME billing process. Then continue reading to access additional documents that’ll give you a more in-depth explanation.
Become an Accredited Medicare DME Supplier
Since Medicare is one of the largest insurers for DME supplies, you’ll be billing them frequently. If you haven’t become a supplier, you can review the National Supplier Clearinghouse (NSC) website to learn more about supplier enrollment-related processes, rules, and regulations.
Meet the Necessary Documentation Requirements
This industry is thoroughly regulated. Any mistakes will result in an unpaid claim. Providing the necessary documentation is one way to avoid delayed payments. The supplied DME item and the insurer will determine what type of documentation you’ll need to include with your claim.
Here’s a list of some of the typical documents you might need to submit.
- Advance Beneficiary Notice of Noncoverage (ABN)
- Beneficiary Authorization
- Certificate of Medical Necessity (CMN)
- Continued Use and Continued Medical Need
- Patient Medical Record Information
- Medical Records to Justify Medical Necessity
- Proof of Delivery
- Refill Documentation
- Standard Written Order
Input Correct Data
Another common reason for claim denials is incorrect terminology, typos, or insufficient information. Again, this is where having a qualified billing specialist is essential. They are familiar with the industry terminology and claim submission process. Here are some items you’ll need to keep in mind when billing claims.
- Have the patient sign the assignment agreement
- Meet the beneficiary signature requirements
- Use the correct billing form: CMS-1500
- Understand the incomplete (or invalid) claims processing terminology
- List the correct place of service for the DME
- File claims on time
- Know when it’s appropriate for equipment upgrades
Resources to Help Educate You on DME Billing
You can continue with your DME billing education by viewing some of the resources below.
You’ll learn an overview of CMS’s billing guidelines, including commonly used words and how you can stay current on the changing regulations.
This article explains the typical DME billing process, starting with a patient order to claim submission.
Read some of the most frequently asked questions about documentation guidelines for DME supplies.
This PDF provides general instructions on billing and claims processing for DME, prosthetics, and orthotics (P&O), parenteral and enteral nutrition (PEN), and supplies, along with additional in-depth information regarding Medicare claims.
You have access to information on enrollment, documentation, claim submission, coverage, appeals, overpayments, and more.
You can read articles on billing instructions, correct coding, the Competitive Bidding Program, CR Modifier Usage for COVID-19 PHE, and more.
Learn How Outsourcing Can Increase Your Claim Approval Rate
Once you develop and maintain a DME billing system within your company, you’ll see a positive trend of increased claim approvals and more. As a full-service DME billing company, the Medbill staff can help you and your team meet your billing goals through outsourcing.