Results Driven DME Billing Service Provider
< 30
Days in AR
10-15%
Revenue Increase
97%
First Pass Ratio
96%
Collection Ratios
98%
Clean Claims Rate
Overview of DME Billing Services
The U.S. Department of Health and Human Services reports that over 3 million Medicare beneficiaries rely on DMEs. Naturally, efficient DME billing is required to collect timely reimbursements for providing these assistive equipment.
With such a high number of patients needing DMEs like wheelchairs, nebulizers, crutches, blood sugar meters, and even hospital beds, providers find it difficult to keep up with the paperwork, file claims on time, and resolve payment disputes.
Our DME billing services include the following to help you collect accurate payments on time.
- Charge Capture and Entry
- DME Coding and Billing
- Claims Processing
- A/R Follow-Up
- Denial Management
- Payment Posting
- Data Analysis and Reporting
Common Challenges in DME Medical Billing
Like all the other medical specialties, DME suppliers also face a number of challenges during medical billing and coding. In fact, some may argue that DME medical billing is more challenging than other specialties due to its unique coding guidelines, constantly changing regulations, distinct payers policies, and shifting reimbursement rates.
However, understanding the common challenges in DME billing is crucial if you want to mitigate denials, ensure efficiency, and boost your bottom line for financial success and sustainability.
Complex Coding
Coding DME services can be more complicated than reporting procedural codes for other medical specialties. This is because DME providers are required to use CMS’s HCPCS level II codes and modifiers for accurate billing. These codes are updated quarterly! Moreover, each HCPCS code must match the ICD-10 diagnosis code.
Lengthy Coverage Checks
Checking insurance coverage for DMEs can be more time-consuming than verifying patient eligibility and benefits for other medical services. This is because determining whether the equipment or devices fall under ‘comfort and convenience’ or ‘medically necessary’ items is not always easy. Moreover, you need prior authorization for specialized equipment.
Documentation Issues
A large proportion of DME medical claims are denied because of insufficient documentation. Besides a physician prescription, you must submit the patient’s complete medical record, equipment factory invoices, and even warranty statuses to support your medical claim and prove the medical necessity of the DME rendered to the patient.
Varying Payer Policies
Keeping up with the changing payer policies is a major hurdle in DME medical billing. Medicare, Medicaid, and private insurance payers have different guidelines for billing DMEs, and failure to abide by these can result in immediate denials. Moreover, equipment rental and purchase rules vary across payers.
Outsource DME Billing Services to MediBill MD
Survey findings reveal that the medical claim denial rate for durable and home medical equipment (DME & HME) suppliers can be up to 30%. This can be a severe setback for small and growing DME/HME providers who are already struggling because of Medicare’s reimbursement rate reductions.
We get it. DME billing is more challenging than other medical specialties. However, denials can be prevented if you outsource DME billing services to a credible medical billing company like MediBill MD. At MediBill MD, we use human expertise and technological innovation to streamline the DME billing process, ensuring up to a 98% clean claim rate, 96% improvement in collections, and up to 15% revenue upticks.
Our DME billing team comprises AAPC-certified professional coders who understand the unique challenges of coding durable medical equipment, devices, supplies, prosthetics, and orthotics. They use the CMS-approved and updated HCPCS level II coding system to assign codes and modifiers to the highest level of specificity for supplying DMEs.
Outsourcing DME billing services to MediBill MD is more cost-effective than setting up and maintaining an in-house billing department. We only charge a fraction of your total monthly collections and keep our rates lower than the market average to ensure a swift and steady increase in your revenue.
We understand that billing for durable medical equipment involves stringent verification of insurance coverage, obtaining pre-authorizations, accurate charge entry, and timely claim submission. Our team works around the clock to fast-track these processes without compromising on the quality of deliverables.
Our DME billing and coding team stays current with the changes in government regulations, payer policies, and coding systems/guidelines to ensure that every claim filed is clean, compliant, and accurately coded. With HIPAA and ISO certifications as our accolades, we guarantee 100% conformance to laws.
We use robotic process automation (RPA) for repetitive and logic-based tasks like insurance eligibility checks, charge entry, claim scrubbing, and sending payment reminders to speed up the billing process, reduce errors, and lower operational costs. It helps us deliver quick, error-free, and affordable results to our clients.
Every DME client is assigned a dedicated project manager who maintains effective communication with the healthcare provider, insurance payer, and DME supplier to streamline billing, resolve payment disputes, track claims progress, and record collections. Regular consultations and detailed reporting are a part of it.
Delivering DME billing expertise across the country! At MediBill MD, we leverage our remote operability to offer proven and customized DME billing solutions in every corner of the country, regardless of the time and distance. DME centers of all types and sizes can entrust us with their billing and coding to achieve operational excellence, maximized reimbursements, and revenue growth. Contact us for streamlined DME billing, coast to coast!
Overcome DME Billing Challenges with MediBill MD
DME billing comes with its own unique challenges. From incorrectly billing Medicare for providing DMEs to a non-Medicare beneficiary to inaccurate HCPCS coding and documentation gaps to missing modifiers, several factors can derail the DME billing process, leading to denials and a loss in revenue. However, partnering with MediBill MD can help you avoid these pitfalls and collect your due payments.
| Common DME Billing Challenges | MediBill MD Solution | |
|---|---|---|
| Not Verifying Patient’s Eligibility and Benefits | We thoroughly verify each patient’s insurance coverage by asking for their Medicare Beneficiary Identifier (MBI) number during appointment scheduling and accessing their updated patient record. | |
| Separately Billing Medicare for DMEs Provided During Inpatient Stays | Inpatient services provided to Medicare beneficiaries cover DMEs. Our billing team makes sure that separate claims are not filed to Medicare for DME services during hospital inpatient stays | |
| Failing to Prove the Medical Necessity of the Equipment or Device | To bill for DMEs, the healthcare provider must submit a written order/prescription to prove the medical necessity of DME. We ensure this signed prescription is submitted with the claim. | |
| Not Obtaining Prior Authorization for Specialized Equipment and Supplies | Prescription and provision of specialized equipment like prosthetics require prior authorization. We contact the insurance payer and get the approval within 48 hours to fast-track treatment. | |
| Inadequate Documentation to Explain If the Equipment Was Rented, Purchased, or Purchased After a Trial Rental | We submit supporting documents related to equipment like purchase/rental orders, factory invoices, and warranty statuses to help the payer understand if the DME was rented or bought. | |
| Missing or Incorrect Modifier to Explain the Condition of Rented or Purchased Equipment | Appropriate use of modifiers with HCPCS codes is necessary to highlight the condition of the DME. Our coders are proficient in modifier usage and use the correct ones for reimbursement. | |
Lowest Prices Guaranteed
Get an industry-low flat 1% rate for the first month of service. MediBill MD’s full-stack DME billing services are available at a promo rate of 1% of collections. Promising unmatched precision at unmatched rates!
Get In Touch with Our
DME Billing Experts
Reach out to our DME billing specialists today and get the best reimbursement rates for your assistive equipment and devices. Optimizing your revenue, one claim at a time!
FAQs
MediBill MD’s customized, affordable, and proven DME billing solutions make it a good choice for a partnership. Our billing experts carefully assess your practice's needs to suggest tailored services at some of the lowest market rates. We ensure top quality, regulatory compliance, and industry best practices in all our deliverables.
You can outsource DME billing services to MediBill MD for 2-5% of your net monthly collections. However, new clients can enjoy our promo rate of flat 1% for the first month of service.
Besides assigning HCPCS Level II codes for supplying durable medical equipment, keeping up-to-date with the changing regulations is the most challenging aspect of DME medical billing. Frequent changes in the CMS’s policies affect the coverage and reimbursement rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), keeping providers on their toes.
Durable medical equipment (DME) billing is an intricate process and an essential part of revenue cycle management (RCM). It includes submitting claims to insurance payers for reimbursement of medical equipment, devices, and supplies for repeated use, like wheelchairs, ventilators, blood sugar monitors, etc.
Medicare has a few guidelines when it comes to DME medical billing. First, only the Medicare-listed providers can file DME claims to Medicare. Second, the patient must be a Medicare beneficiary and have coverage for DME services under Part B. Third, the provider must prove the medical necessity of the equipment and supplies during claim filing. Fourth, the latest HCPCS coding guidelines must be followed for accurate coding of medical equipment, prosthetics, and supplies, and modifiers must be used where necessary. Use the CMS-1500 form when you are ready to file your DME claim.
Yes. A physician’s office can bill for DME services if the DMEs are furnished or fitted in the same building or room where the patient is being treated. The physician can bill government and private insurance payers after ordering and furnishing the DME for the patient’s treatment and management.
No. Hospitals cannot bill Medicare separately for providing DMEs during inpatient stays. This is because the DMEPOS reimbursements are covered under the Medicare Part A inpatient stay payments in alignment with the PPS rate.
No. A DME supplier cannot bill Medicare or Medicaid if the company is not enrolled in the CMS’s PECOS database. The provider must be enrolled in the CMS network to collect reimbursements for equipment and supplies. For enrollment, you must post a surety bond to the enrollment contractor, after which you will get DMEPOS accreditation from a CMS-approved organization.
