DME

Durable Medical Equipment Billing Services

Durable Medical Equipment (DME) reimbursement can be a tricky area for providers to manage due to the requirement to prove necessity for the DME, the differences in evidence depending on an individual’s circumstances, and the complexities involved in medical billing codes. With all issues considered, many medical practices lose a large chunk of money each year on administrative expenses and unpaid claims. Using a billing specialist can help to achieve increased success with DME claims and to decrease the pressure on your staff to collect the adequate amount of evidence required to substantiate DME claims.

Effectiveness of Claims Submissions

Many claim denials occur when DME devices are claimed incorrectly, with the assumption that they will be covered. The issue with DME claims is that coverage is circumstantial and depends on the patient’s situation. For example, a walker required by an elderly patient in a permanent nursing facility may be reimbursed, however the same type of walker used by a non-permanent resident who uses a one-off nursing facility would not be eligible in a claim for a DME device.

Experience with this type of claims handling and understanding the minute situational differences is essential for effective reimbursement. Without knowledge of DME devices that are covered, practices often submit unsuitable claims, which turns in to a waste of your staff’s time.

Classification of DME

Equipment such as orthotics, back braces, vena flow pumps, and intermittent limb compression devices, are DMEs that may be recommended by providers to help with treatment, rather than forming a complete treatment episode. Proving the necessity for a DME device can be a tricky one, which can lead to a extra paperwork to show their requirement for treatment due to the fact that the DME is only an element of the treatment process.

5 Star Billing Services utilizes a team of experienced specialists, who have years of experience dealing with tricky DME classification situations, to help you increase your DME reimbursement. We can help facilitate the process by:

  • Monitoring the process from the very beginning to the end of the medical episode.
  • Reviewing CPT and DX codes to make sure they are supported.
  • Putting the DX codes into the proper order and adding the correct modifiers that are needed to ensure payment.
  • Helping to process documentation after providers have established Establishing the necessity for a DME device within a treatment episode.
  • Helping to submit the necessary documentation to gain reimbursement after the provider has obtained the signed ABN/Waivers from the patients and scanned them in the patient’s chart.

For example, in a DME claim, we our coders will help to build a description of the patient’s treatment using a step-by-step process to ensure all documentation is gathered, including necessary evidence such as photographs and progress charts, as well as the patient’s ability to use the DME equipment.

Coding Complexities

The medical billing process is no easy task, and staff often find it extremely difficult to stay on top of regulatory requirements and fee coding. By outsourcing your billing function to a responsible provider, coding specialists with clinical experience and with up-to-date knowledge can help to improve the revenue cycle, and alleviate the staff pressure of billing.

From accurate identification of eligible claims, to facilitating the process to gather necessary documentation for DME claims, our team has a wealth of knowledge and experience to guide claims processing. This can lead to significant benefits for your practice including improved revenue, administrative cost cutting, and allowing your practice to focus on what really matters: the delivery of care.

For more information on how outsourced billing solutions can help to benefit your practice, contact us online or call us at 480-821-1371.