If you’re new to the industry, you’ve seen a fair share of acronyms in a short amount of time: DME, DMEPOS, LCD, RAC. If you’re looking for clarification, you’re in the right place! This article will answer what does DME stand for, some other common acronyms with their definitions, and the basics of successfully submitting a DME claim to Medicare and third-party insurance companies.
What Does DME Stand For?
To answer the question, DME stands for durable medical equipment. Durable medical equipment includes items and supplies that can withstand repeated use in a person’s home, and it helps with their daily life. If you need clarification on whether something is considered DME, does it meet the following criteria?
- Is it durable enough to be used over and over again?
- The primary purpose is to serve a medical condition
- Something that you can use in a home
- Typically, it can last for 3+ years
In a previous article, we look in-depth at DME in the healthcare industry. Additionally, there’s another acronym you’ll see, DMEPOS. DMEPOS is the same as DME, and it also covers items that pertain to prosthetics and orthotics. For example, body braces and artificial limbs (including eyes).
What Does LCD Stand For?
Within the DME industry, LCD stands for Local Coverage Determinations. The purpose of LCDs is to provide you with information on “reasonable and necessary” criteria according to the Social Security Act. It helps to ensure all Medicare beneficiaries can access any medically necessary suppliers and services.
What Do RAC and CERT Mean?
Both RAC and CERT are auditing contractors for CMS. Each one has a specific purpose and reason for being conducted, but the primary focus of Medicare audits is to ensure the accuracy of the claim.
Below are the three most well-known claim audits for the DME industry.
- RAC – Recovery Audit Contractor Audits
- CERT – Comprehensive Error Rate Testing Audits
- UPIC – Unified Program Integrity Contractors Audits
Helpful Tips for Successfully Submitting DME Claims
Now that you know more about the DME industry’s acronyms, here are some practical tips for billing those items to Medicare and third-party insurance companies for reimbursement.
- Know your HCPCS Level II codes
- Be able to describe or detail each item using the appropriate modifier correctly
- Stay current on all industry guidelines (which can change frequently)
- Always ensure patient information accuracy
- The Centers for Medicare and Medicaid Services (CMS) and commercial insurance companies set different rules and guidelines
- You can sell or rent DME items to patients
If you want to read more details about billing DME, then check out these resources.
- Quick Tips on How to Bill DME Claims
- A Beginners Guide for DME Billing
- 4 Steps on Billing DME Claims
When You’re Ready to Bill DME, Call Medbill
When you work with the right DME partner, you’ll take steps to help your business to thrive. And Medbill could be the billing partner for you! We provide services to assist DME suppliers and providers in accurately billing claims and receiving on-time payments.
Talk to our team to learn how we can help to ensure you have a reliable collection rate for your DME claims.