Durable Medical Equipment billing is an industry with ever-changing payor policies, reimbursement regulations, and compliance. You can succeed in this constantly changing industry by having a solid understanding of:
- DME billing processes
- How it differs from other medical billing procedures
- Some critical components to the industry
- Understanding claims audits
What are DME and DMEPOS?
Durable Medical Equipment, or DME, is medical equipment that helps a person with daily life at home (or non-hospital setting). DMEPOS items include the same DME medical equipment along with Prosthetics, Orthotics, and Supplies items. A DMEPOS item usually is used repeatedly, lasts 3+ years, and serves a medical purpose.
DMEPOS items include:
- Artificial limbs
- CPAP machines and equipment
- Hospital beds
- Orthotics (i.e., neck braces)
- Prosthetic devices
- Various medical supplies
- Wheelchairs and accessories
- And more
DME billing is the process of submitting and receiving payment for a claim from the insurance company. Implementing, maintaining, and educating staff on proper billing is vital to a DME provider’s success. Staying up to date on industry guidelines and compliance is critical to ensure clean claims are submitted and you receive timely payments.
How is DME Billing Different from Other Medical Billing?
DME billing has two main components; it allows for rentals and requires HCPCS (Healthcare Common Procedure Coding System) codes. When submitting insurance claims, HCPCS helps to identify the billed item or service provided. For instance, HCPCS code E0607 represents a home blood glucose monitor.
5 Things That Will Help You to Better Understand DME Billing
DME billing is a complex and ever-changing industry that requires constant learning and a successful billing process to ensure timely paid claims. Here are five things that can help you to understand the complex world of DME billing better.
#1 How to Bill DME?
You will need to create and maintain a thorough and efficient billing process from intake to claims submission. A proper billing process will have a positive ripple effect throughout the company and help providers receive the maximum reimbursement available.
#2 DME Billing Guidelines
DME payor medical policies often change across the various product lines. Make sure to have a system in place to stay current on all changes before submitting a claim. Regularly checking the CMS’s website is an efficient way to keep up to date on all Medicare and Medicaid DME guidelines.
#3 DME Billing Specialist
A DME billing specialist’s goal is to ensure all submitted claims are accurate and contain all the required paperwork to reduce the number of rejected claims. They have several responsibilities, including ensuring compliance with payors guidelines, checking and correcting HCPCS codes, submitting and following up on claims, and more.
#4 DME Billing Services
Outsourcing DME billing services can provide you access to DME billing specialists. Those specialists can process claims, check on claim status, stay current on all payor guidelines, and more. Outsourcing billing services can free up extra time to be sent on marketing or bringing in new business.
It’s important to note that no DME billing company and its billing services are the same, so make sure to gather all the needed information to make an educated choice before selecting the best one.
#5 DME Billing Companies
Outsourcing to a DME billing company can help you stay current on policy changes and alleviate some time-consuming medical billing tasks. Finding and working with a trusted and reputable DME billing service, like Medbill, can increase timely paid claims and reduce the amount of rejected claims.
Select a company that’s more than just a claims submission service. A DME billing company, like Medbill, can become an extension of your billing department and can provide you with numerous services from A/R to audit assistance to revenue cycle management.
Medicare DME Claims Audits
Medicare DME claims audits help to ensure all claims submitted are accurate and correctly paid. If you receive an audit request, make sure you respond by the deadline, send all the requested documents, and begin reviewing the audited claim internally.
There are several types of Medicare DME audits, including:
- Comprehensive Error Rate Testing (CERT) Audit
- Medicare Administrative Contractors (MACs) Audits
- Recovery Audit Contractor (RAC)
- Unified Program Integrity Contractors (UPIC) Audit
It’s important to note that each insurance payor will have their own auditing entity as well.
Tips on Minimizing Claims Errors
Develop and maintain an audit ready process to minimize potential claim errors. Here are five tips to get you started:
- Review your current claims process (from intake to submission)
- Review your denial rates and reasons
- Audit yourself and look for potential errors
- Analyze and make any necessary changes
- Repeat regularly
Navigating the DME Billing Industry
After reading the above information, it’s clear that DME billing is an extensive industry that is regularly inspected, audited, and ever-changing. Investing time and resources to develop a billing process, properly training staff, and promoting a culture that encourages learning is needed to stay current.
Sometimes additional support, through outsourcing, can help to reduce the time-consuming tasks. Outsourcing provides extra time and staff for other business matters (marketing, increasing sales, etc.) Finding a trusted DME billing company to help with your DME medical billing needs can make all the difference.
Things to Consider When Reviewing a DME Billing Company
Keep these questions in mind during your DME billing company search.
- What is the document review process?
- Are claim denials reviewed and managed?
- Will they look for claims rejection trends to better improve the billing process?
- Is personalized support an option?
- Will my staff be educated to increase future successful billing practices?
- Do they stay up to date on changes to payor policies?
- Will they review my A/R process and offer improvements?
How to Know if DME Outsourcing is Right for Me?
Outsourcing doesn’t have to result in staff reduction. The right DME billing company can become an extension of your billing department. Medbill is a top DME billing company and has a 100% U.S.-based staff. The Medbill staff is trained and skilled in preparing your company in all aspects of DME billing with personalized support.
Contact us today to learn how we can help you.