Quick Tips on How to Bill DME Claims

Billing DME – DME billing guidelines – how to bill DME claims – if you’re researching information about submitting durable medical equipment claims, there’s a good chance you’ve searched for those phrases. And you might have already learned about HCPCS Level II codes, modifiers, Certificate of Medical Necessity, and more. 

If you want easy-to-understand, accurate billing information, look no further. At Medbill, our specialists are proficient at billing DME claims. So, we’re here to provide you with straightforward billing tips on how to bill DME claims for your business. 

Quick Introduction to DME Billing

In the simplest of terms, DME billing is when you submit a claim for payment for one or several DME items you provided to a patient. Although DME billing is anything but simple, with enough education, you can learn how it works. Many DME providers and suppliers have had success with their claims. You need to have a team of people who have a strong understanding of:

  • DME billing processes
  • How DME billing differs from other medical billing practices 
  • The main components of the industry
  • DME claims audits

Accurate Claims Submission is Essential to Success 

Your claim will receive a rejection for various reasons:

  • Inaccurate patient information
  • Incorrect HCPCS code
  • Outdated DME guidelines 

And when the payer rejects your claim, it’ll need to be reworked and submitted, which results in delayed payments and additional work for your staff.

Tips on How to Bill DME Claims

As you continue to educate yourself on how to bill DME claims, remember that it’s a straightforward process if you know the components. Here are some helpful tips to navigate DME billing guidelines. 

DME Billing Background 

  • The Centers for Medicare and Medicaid Services (CMS) sets the rules and guidelines for the DME industry, including:
    • The type of equipment they consider DME
    • The billing processes for Medicare reimbursement
    • The total amount you can receive for a reimbursement from Medicare recipients 
  • Commercial insurance companies set the rules and guidelines for:
    • Their own billing processes for reimbursement 
    • The total amount you can receive for a reimbursement from their recipients 
  • DME billing differs from other types of medical billing because it:
    • Allows for equipment rentals 
    • Requires HCPCS codes
  • If you want to sell or rent DME, you need to become an accredited supplier through Medicare 

The DME Billing Process

  • Before supplying a patient’s equipment, check their benefits and eligibility for the item and watch out for:
    • The utilization policy and guideline – i.e., not all Medicare beneficiaries can receive the same equipment item if it’s within five years.
  • Confirm the accuracy of the claim by:
    • Correct place of service
    • Correct modifier and codes
    • The billable date of service is the date you dispensed the equipment
  • For rentals (if you’re unsure), verify with the insurance payer: 
    • Should the claim include the start-to-end date?
    • Does the item ever transfer ownership to the patient?
    • If the title transfers, how many months of payment before it transfers?

Additional Resources

Learn How Outsourcing Can Assist with Your Billing Needs 

At Medbill, we’re a full-service DME billing company that assists providers with their billing needs, including:

  • Claims submission 
  • Daily billing activities 
  • Managing denial trends
  • Navigating the industry’s guidelines and changing regulations
  • Price table updates

Our team can assist you if you need help increasing your on-time collection rates or reviewing past claim denials. Contact us using our online form or call 866-369-5423 to talk to a team member.