How to better understand the complexities of DME billing
Efficiency is the key to success for Skilled Nursing Facilities (SNFs). You’re required to find innovative ways to improve your patient experience while also reducing costs.
If you are a DME provider or your facility does Durable Medical Equipment (DME) billing then you already understand the importance of efficiency. Keeping current on payor guidelines and policies and ensuring compliance for DME billing is very challenging.
Learning to maintain an efficient DME billing process and clean claims submissions can require a significant investment in highly skilled resources and time. If you don’t have an experienced DME biller, you’re likely to see a large number of rejected claims, lower reimbursement rates, decreased revenue, and increased costs.
Understanding the complexities of DME billing requires top-level coding, an efficient billing process, and constant employee education. Let’s break down some helpful tips so you can better understand the complexities of the DME billing process.
What is DME Billing?
According to HealthCare.gov, Durable Medical Equipment (DME) is “equipment and supplies ordered by a healthcare provider for everyday or extended use.” DME may include oxygen equipment, wheelchairs, crutches, blood testing strips for diabetics, or walkers to name a few. All DME requires a prescription from a licensed healthcare provider with the intent to use in the home.
DME billing is the process of submitting and receiving payment from an insurance company for a patient’s approved medical equipment.
DME vs. Medical Billing and Coding
DME billing is a complex and lengthy process that requires specialized training beyond traditional medical billing and coding. DME billers must have in-depth knowledge of various medical situations and the specialized DME that accompany them.
Below are four key differences between DME and medical billing and coding.
- DME billing uses HCPCS (Healthcare Common Procedure Coding System) Level II codes. In general, medical billing only uses HCPCS Level I codes.
- Modifiers are mandatory for DME billing. Modifiers determine if a claim will be denied or not. For medical billing, modifiers are optional and typically will not directly impact the claim.
- There are DME codes to specify renting versus owning equipment. And, the codes are designated to specific items, not procedures.
- DME reimbursement is a complex and lengthy process requiring a great deal of documentation and approvals. Whereas medical reimbursement is typically based on the revenue codes or the procedure codes.
4 Helpful Tips to Improve DME Billing
It’s quite evident that DME billing is complex. Due to its complex nature, it can take time to fully understand.
Improve your DME efficiency by following these 4 helpful tips.
1. Provide Correct Documentation
It may seem simple, but providing correct documentation is everything when billing for DMEs. If you are unsure what documentation is required, we recommend checking with the insurance company first.
Tip: HCPCS Level II codes ending in “99” require additional supporting documents when submitting the claim. When you see this code ensure that the correct paperwork is included to avoid the insurance company suspending the claim.
2. Establish Medical Necessity
For a patient to receive a DME, it must be medically necessary. Meaning that their medical record indicates that it’s a medical necessity to assist the patient in the treatment of their diagnosed medical condition.
Tip: Check a patient’s policy and Local Coverage Determinations (LCDs) to determine what needs to be included as proof of medical necessity.
3. Stay Up-to-Date On DME Billing Policies
DME payor policies change frequently. Staying up-to-date on these policies will help you to run a smooth DME billing operation.
Tip: Use the additional DME billing resources below to help stay up-to-date on DME billing policy changes.
4. Validate Insurance Coverage
Before the patient receives a DME, validate their insurance and understand what devices are covered. Validating the insurance coverage early ensures you are billing for the correct items and have the necessary documentation.
Tip: Validate your patient’s DME insurance before seeing the DME provider.
Additional DME Billing Resources
Stay current on DME billing updates and changes with these additional resources:
HCPCS Level II Coding Procedures
CMS DME Billing Equipment Center
Federal Register for DME Billing Updates
Outsourcing Your DME Billing with MCA
DME billing requires an in-depth knowledge of payor policies and procedures. Additional DME billers must understand reimbursement standards and coverage guidelines from Medicare, Medicaid, commercial, and private insurance plans.
Maintaining a DME billing process can require a significant investment in both time and money. Outsourcing your DME billing services can alleviate both financial and time constraints. Allowing you to focus on other areas of your facility.
Benefits of Outsourcing your DME Billing
Outsourcing your DME billing provides several benefits including:
- Improved DME collection rates
- Reduces operational costs
- Decreases your days’ sales outstanding (also known as days’ in AR)
- Frees up capacity to focus on other operational requirements
Your facility might benefit from DME billing services if:
- You struggle to find, retain, and educate a DME biller.
- You find it difficult to stay current on DME billing regulations.
- You have recurrent DME billing errors including coding, insufficient documentation, or poor claims management.
- Your collection rate is lower than you would like.
MCA Medical Billing Solutions may be able to help. At MCA, we have dedicated DME billing experts who partner with our clients to fulfill their DME billing needs. We can help you with all or part of your DME billing needs.
Drop us a note or give us a call at 866-609-5880 to learn more about how MCA can help you improve your DME billing.
About MCA Medical Billing Solutions
MCA is a full-service revenue cycle management company dedicated to helping skilled nursing facilities advance their revenue cycle management. We provide claims creation, submission, and follow-up to Medicare, Medicaid, and all commercial insurers.
When you choose MCA you can expect experienced business insight, skilled billing intelligence, data extraction and management, and cloud-based documentation. MCA is here to help you streamline your revenue cycle process to produce consistent, high-quality outcomes.
“Durable Medical Equipment (DME) – HealthCare.gov Glossary.” https://www.healthcare.gov/glossary/durable-medical-quipment-dme/. Accessed 24 Mar. 2022.
“Durable medical equipment (DME) coverage – Medicare.gov.” https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage. Accessed 24 Mar. 2022.