Durable Medical Equipment or DME has undergone regular renovations over the years due to changes in regulatory compliance. Constantly changing the DME billing landscape always creates so many challenges for the medical equipment suppliers and medical practitioners. DME contributes to approximately 2% of Medicare’s annual expenditure. Then denials are some of the stressful reasons for healthcare professionals while billing Durable Medical Equipment.
Not all DME billing claims will return proper revenue reimbursements for healthcare professionals. DME billing has the maximum denials than any other field in the healthcare services. Its due to various reasons and factors but all these denials cause major damage for revenue payments in the revenue cycle management process.
Some other concerns faced by DME providers, such as fewer collections, billing errors, training expenditure for new staff, discontinued operations in the absence of office staff. DME billing needs proper attention and concentration. Even the smallest mistake can lead to very slow productivity and revenue halt.
What is DME billing?
- Durable Medical Equipment is therapeutic equipment prescribed by a licensed healthcare practitioner to patients suffering from certain medical conditions.
- DME billing covers only if the equipment is used for prescribed medical conditions and not for convenience and beyond reasonable requirements of the patient.
- Examples for DME are Nebulizers, Ventilators, Kidney machines, etc. DMEs are mostly meant for therapeutic benefits for those patients suffering from chronic conditions or long term illnesses.
- Yet, it may or may not be useful for patients without any chronic diseases too. DME is durable and the time period can be more depending on the sickness of the patient.
What is DME Coding?
- DME billing agencies, data analysts, and coding experts use a customized DME coding system that puts a track of all codes in DME billing services.
- DME coding helps the distributors and vendors keep track of DME billing services efficiently so that claims won’t be missed and will be fast tracked. It’s important to learn that the coding system for DME cannot be a substitute for HCPCS releases.
DME billing Services in a Gist
- Right after the invoice is created, it’s the most important or necessary step to pile up those documents and medical records for electronic claim submission.
- A deep check of the documentation is important before the electronic claim submission. The document needs to be error free and clear with complete information provided with essential details.
- If any documents go missing, there are denials ready to shoot healthcare professionals or if the claim falls under non-compliance.
- Many healthcare professionals prefer outsourcing DME billing services to prevent denials and revenue losses.
- Medical billing companies usually focus on the documentation and medical records to make sure the claim is ready to go for a submission.
DME Billing and Insurance Coverage Indications
- DME billing services can be covered if the patient has DME benefits and the equipment is prescribed by the healthcare professional for a specific long term condition, disease, or illness. The equipment has an exception to exclude in the patient benefit plan document or history.
- For DME billing, DME must not be consumable unless necessary for effective use of covered DME.
- Patients cannot use DME unless there is a severe disease illness or disability.
- DME must be provided or should order by healthcare professionals for outpatient use in-home settings.
- DME must be used only for medical purposes or medical use.
DME Billing Coverage Limitations and Exclusions
If there is one or more DME to meet the functional need, coverage benefits are applied and available only for one DME with the minimum specifications for patient requirements such as:
- Standard power wheelchair Vs custom wheelchair
- Standard bed Vs semi-electric bed Vs complete electric or floating bed
This limitation is specifically meant to eradicate coverage for deluxe or additional components for a DME item and is not much required to meet the minimal specifications of patients to treat the chronic disease or illness.
When a patient buys or rents a DME surpassing the mentioned guidelines, the patient is held responsible for the cost difference between the items or devices purchased or rented.
The DME billing services excluded from coverage include:
Accessories or devices that are included in the DME services are mainly meant for the patient’s comfort and convenience. Here are some DME devices that are not covered by insurance companies:
- Air conditioners
- Air purifiers and filters
- Batteries for non-medical equipment
- Non-medical mobility devices.
These exclusions are not applicable for Pediatric DME billing coverage.
Covered DME Billing Services
DME billing services or healthcare services including supplies or pharma products to decide the following:
- DME is provided for preventing, evaluating, diagnosing, and treatment of a chronic disease or illness, injury, mental illness, addictive disorder.
- DME that’s medically necessary.
- Not excluded and described under covered services.
We hope you now have an idea of DME billing services.
With DME billing outsourcing to Info Hub Consultancy Services, you get to partner with a reliable offshore DME billing company that is overly focused on simplifying your billing process and assuring that you receive accurate compensation in the shortest possible time.