Durable Medical Equipment in short commonly referred to as DME has undergone constant improvements due to changes in regulatory compliance. Staying up to date with the changing DME billing requirements is one of the most challenging issues. DME accounts for about 2 percent of Medicare’s total spending. Denials are among the most stressful issues for healthcare professionals who have to bill Durable Medical Equipment.
However, not all DME invoices will result in reimbursements for healthcare professionals. In reality, DME billing faces the highest amount of denials than other claims. There are many reasons and causes, but they all cause significant damage to revenue-related payments as part of the process of managing revenue cycles.
There are other issues faced by DME providers. These include, less collection of billing errors, increased the cost of training for new employees, and suspended operations in an absence of office personnel. DME billing services need to be handled with a high degree of concentration. Any mistake could result in a slow efficiency and a complete stop to revenue.
What exactly is DME billing?
DME is a term used to describe Durable Medical Equipment that is a therapeutic device recommended by certified healthcare experts for patients suffering from specific medical conditions. DME billing will not be covered by the use of equipment to ease the burden of medical needs that the person.
Examples for DME include Nebulizers, Ventilators, Kidney machines, etc. They are typically used for the benefit of therapeutic treatment for sufferers with long-term health issues or chronic diseases.
It could or not be effective for patients who do not have any chronic illnesses. However, DME is long-lasting, and its duration may be extended based on the health condition or illness of the person.
What is DME Coding?
DME billing firms, as well as coders and data analysts, typically use a customized DME Coding system that is maintained as a list of all codes utilized in DME bill services.
It allows vendors and distributors to effectively keep track of DME billing services so that claims will not be overlooked and can be processed quickly. It’s crucial to know that the DME codes cannot be an alternative to HCPCS releases.
Let us explain DME Billing Services:
1) When an invoice is issued, it’s crucial or vital to collect these documentation and health records to be used for the electronic submission of claims.
2) An exhaustive examination of the documents is necessary before submitting an electronic claim. The document should be clear and error-free, and complete with all the essential information.
3) Denials are prepared to take care of healthcare professionals if documents are missing or if the claim is deemed to be non-compliant.
4) This is why numerous healthcare professionals opt to outsource DME billing services to avoid denials as well as revenue loss.
5) Medical billing companies typically focus on the medical records and documentation and make sure the claim is prepared to be submitted.
DME Billing and Insurance Coverage Indications:
DME billing services may be paid for when the patient has DME benefits, and the device is recommended by healthcare professionals in order to diagnose or treat a long-term illness or disease, and the equipment isn’t exempted in the benefits plan or the history of the patient.
1) To be used for DME payment, DME must not be consumable or disposable, unless absolutely necessary to make use of the covered DME.
2) The patient is not allowed to utilize DME absent impairment or illness.
3) DME is required to be supplied or requested by health professionals for outside patient use in home settings.
4) DME should only be used for medical or therapeutic use.
DME Billing Coverage Limitations and Exclusions:
When a patient utilizes any or all of the DME to meet the requirements of their functional needs, the benefits are valid and accessible only for only one DME that meets the minimum specifications necessary for the patient’s requirements. These comprise:
A) The standard wheelchair versus. customized wheelchair
B) Standard bed vs semi-electric bed vs. complete electric or floating bed
This restriction is specifically designed to limit the coverage of deluxe or other components of a DME product and isn’t enough to satisfy the requirements of patients in order to treat chronic illness or disease.
When a patient purchases or leases a DME over the guidelines mentioned above the patient is responsible for the price difference between the devices or items that are rented or purchased.
A list of DME billing services that are not covered by coverage include:
The devices or accessories part of DME services is mostly intended for the patient’s comfort and ease. Therefore, this DME equipment won’t be insured by insurance firms.
A) Air conditioners
B) Filters and air purifiers
C) Batteries for medical equipment that is not medical
D) Humidifiers
E) Medically-independent mobility equipment. This exemption does not apply to pediatric DME billing coverage.
F) Modification, remodeling, or remodeling of DME to the vehicle or home for the purpose of accommodating DME or patient conditions.
Dental braces. Patients need to check them for specific Dental Benefit Plans and State regulations to ensure DME coverage.
The cranial mold helmet and the bands for the cranium unless they prevent the need for procedure and help facilitate surgery.
Computers and devices that assist and aid in communication as well as the speech of patients.
Monitoring or diagnostic DME purchased for use at home unless recommended by medical experts.
Oral appliances to help with the snoring.
Orthodontic braces improve the alignment and shape of the body.
Exoskeletons that are powered or not.
