DME medical billing is when a DME provider or supplier submits a claim for equipment reimbursement to an insurance company. The claims process is a detailed task starting with intake and ending with A/R. It involves a team of people responsible for handling all paperwork, maintaining compliance with industry regulations, and having an in-depth knowledge of HCPCS Level II codes and modifiers.
If DME medical billing were a straightforward process, there wouldn’t be hundreds of online resources educating readers about the topic. Instead, an online search of the phrase “DME billing” contains over one million results!
What Does DME Medical Billing Include?
Since we’re a DME billing company, it’s not uncommon for providers and suppliers to ask us questions regarding that topic. We can provide you with some general information about what DME medical billing is and the essential aspects of it.
Supplies and Services DME Billing Covers
Medicare and third-party insurances will generally cover any DME supply or service if it meets one of the below conditions.
- Treat a current illness or injury
- Medically necessary
Type of DME Supplies
Medical devices that typically meet the below conditions qualify as DME.
- Therapeutic equipment prescribed by a physician
- Assists with daily living in their home
- Supports patients with long-term medical illnesses or chronic conditions
- It can last for several years and can withstand repeated use
- Examples of devices include:
- CPAP machines
- Hospital beds
- Ventilators
- Wheelchairs
DME Codes and Modifiers
Unlike other medical billing procedures, DME medical billing uses two components, HCPCS Level II codes (Healthcare Common Procedure Coding System) and modifiers.
HCPCS Codes
- Identifies the equipment or service
- Begins with a letter, and additional letters and numbers follow
- Contains five digits
Modifiers
- Explains how the patient will use the product and how long they will use it for
- Indicates any medical records on file to show medical necessity
- Shows if the item:
- Is a purchase or rental
- Is new or used
- Has maintenance or servicing fees
- Has replacement or repair options
DME and Insurance Coverage
There are strict insurance coverage limitations. For example, the payer will deny the claim if it doesn’t clearly explain and show proof that the DME item is medically necessary. Here are a few things you should know about the insurance coverage process.
- The physician must order the DME item for the patient
- DME must treat or diagnose the patient’s disease or illness
- The patient uses it in the home setting
Items or accessories that insurances typically don’t cover:
- Anything meant for the patient’s comfort and convenience
- Deluxe or additional components that don’t treat the condition
- Some of these accessories can have:
- Batteries for non-medical equipment items
- Dental braces
- Orthodontic braces to straighten and change their body shape
- Exoskeleton devices (powered and non-powered)
Learn How a Team of DME Billing Experts Can Help You
The above information was an overview of the basics of DME billing. If you want to continue learning, read our article: A Durable Medical Equipment Billing Guide for Beginners.
The Next Phase
As you continue the education process to learn more, the Medbill team is here to help. We assist businesses with streamlining their billing procedures in all areas, from claims approval to A/R. So when you’re ready to learn how we can be your trusted resource, contact us for more information.