Learning how to bill for durable medical equipment (DME) supplies requires an in-depth knowledge of HCPCS Level II codes and modifiers while following industry rules and regulations. As a DME billing company, we’ve been asked many questions about the best methods for billing DME supplies, and this article will help answer some of those questions.
What is the Process for Billing DME Supplies?
The following steps will go through the typical DME supplies billing process. Read a more thorough article on How to Bill DME Claims here.
Verify the Medical Necessity for the DME
- Patient medical records
- Order prescription
- Detailed Written Order
- Certificate of Medical Necessity
- Proof of prior authorization, if required
Review Insurance Eligibility
Follow Current DME Billing Guidelines
The Centers Medicare & Medicaid Services (CMS) website is always up to date on Medicare and Medicaid DME guidelines.
Maintain Accurate Records for Potential Audits
Follow Up on Claims Submission
If you receive a claim denial, make the necessary corrections quickly to avoid delayed payments.
What are the Most Common Claim Denial Reasons?
- Missing or incorrect data
- Not including the Prior Authorization or Medical Necessity paperwork
- Late claims submission
- Incomplete documentation
- Coding errors
What is the Difference Between DME Billing and Medical Billing?
Unlike medical billing, DME billing requires:
- In-depth knowledge of different medical situations and various DME items
- The use of multiple types of HCPCS Level II codes and modifiers that determines if a claim is approved
- Data that is accurate, one error can result in a denial
- A different type of coding for rentals and purchases is necessary
Is Billing DME Supplies to Medicare Different from Other Insurers?
Yes, while there are some similarities, Medicare does have specific requirements. This article, Medicare DME Documentation Requirements for Providers, will explain those differences in detail.
Is the HCFA 1500 Form Different from the CMS-1500 Form?
No, they are the same form with different names. Learn more about the HCFA 1500 form.
What Do I Need to Know About Documentation Guidelines for DME?
Depending on the DME item, the necessary documentation will vary. This article, DME Documentation Guidelines, will give you detailed information regarding those guidelines.
Where Can I Find a DME Documentation Checklist for my Jurisdiction?
Every claim submission requires several documents to show proof of medical necessity. Implementing a medical necessity documentation checklist can help minimize mistakes. Below is a list of websites for your jurisdiction.
- DME Jurisdiction A – DMEPOS Categories Documentation Checklists from Noridian Healthcare Solutions
- DME Jurisdiction D – DMEPOS Categories Documentation Checklists from Noridian Healthcare Solutions
- DME Jurisdiction B – Documentation Requirement Checklists from CGS A Celerian Group Company
- DME Jurisdiction C – Documentation Requirement Checklists from CGS A Celerian Group Company
Is There DME Software Available to Help with My Billing Needs?
Yes, this article, Finding DME Billing Software with the Latest DME Technology, will help with your research.
How Does Outsourcing Help with My DME Billing Needs?
- Discovers potential gaps in your current processes
- Allows you to maintain your existing staff (if desired)
- Provides training, repurposing plans, and feedback for your staff
- Gives you more control and see the whole picture to make well-informed business decisions
Is DME Billing Outsourcing a Good Investment?
Industry regulations change, staffing challenges, unexpected audits, and more can occur throughout the year. Working with a reputable billing partner, like the Medbill staff, can help you navigate those occurrences. At Medbill, we’re available to help you with any of your billing needs, from AR to patient pay to audit assistance.
Outsourcing with Medbill can lead to significant ROI’s (depending on the type of service).
- Reduce aging AR
- Decrease day sales outstanding
- Improve collections times
- Reduce staffing needs
- Provide ongoing staff education
Contact Us to Learn How We Can Help You
We are a full-service DME billing company with services to assist you with claims submission, daily billing activities, AR, and more. We can also provide a Medbill Benchmark & ROI Review for your business. This review will help uncover the areas of your greatest billing needs, measure your collection rate, and show you an ROI for our services.
Contact us online or by phone at 866-250-4326 to get started.