Durable Medical Equipment in short used as DME has been undergoing perennial renovations due to changes in regulatory compliance. Being constant with changing DME billing landscape always remains as one of the remarkable challenges. DME represents approximately 2% of Medicare’s annual expenditure. Denials are one of the most stressful causes for healthcare professionals while billing Durable Medical Equipment.
Not all DME billing claims will shower revenue reimbursements for healthcare professionals. In fact, DME billing faces the maximum denials than any others. It may include various reasons and factors but all these denials cause a major damage for revenue payments in revenue cycle management process.
There are few more concerns confronted by DME providers, they include, less collections, billing errors, training expenditure for new staff, suspended operations in the absence of office staff. DME billing services should be dealt with concentration. Even the slightest mistake can compound leading to very slow productivity and revenue halt.
What is DME billing?
- DME refers to Durable Medical Equipment which is a therapeutic equipment prescribed by licensed healthcare professionals to patients suffering from certain medical conditions.
- DME billing does not cover if the equipment is used for convenience and beyond reasonable medical requirements of the patient.
- Examples for DME include Nebulizers, Ventilators, and Kidney machine etc. These are mostly intended for therapeutic benefits for those patients suffering from long term medical illness or chronic conditions.
- However, it may or may not be useful for patients without any chronic diseases. But DME is durable and the time period can be extended depending on the sickness of the patient.
What is DME Coding?
- DME billing companies, data analysts and coding specialists almost use customized DME coding system that remains as a directory of all codes in DME billing services.
- It helps the distributors and vendors to efficiently keep tracking DME billing services so that claims won’t be missed and will be fast tracked. It’s very essential to learn that DME coding system cannot be a substitute for HCPCS releases.
Explain DME billing Services:
- Soon after invoice is generated, it’s most important or crucial to pile up those documents and medical records for electronic claim submission.
- Thorough checking of the documentation is required prior to electronic claim submission. The document must be error free and clear with complete information provided with essential details.
- Denials are ready to shoot healthcare professionals if any documents go missing or if the claim falls under non-compliance.
- As a reason, many healthcare professionals choose to outsource DME billing services in order to avoid denials and revenue loss.
- Medical billing companies often pay keen attention to the documentation and medical records and ensure if the claim is ready to go for submission.
DME Billing and Insurance Coverage Indications:
- DME billing services can be covered when the patient has DME benefits and the equipment is suggested by healthcare professional to treat or diagnose a long term disease or illness, the equipment is otherwise not excluded in the patient benefit plan document or history.
- For DME billing, DME must not be consumable or disposable unless essential for effective use of covered DME.
- Patient cannot use DME in the absence of disease or illness or disability.
- DME must be provided or should order by healthcare professionals for outpatient use in home setting.
- DME must be used only for medical purpose or medical use.
DME Billing Coverage Limitations and Exclusions:
- When the patient uses one or more DME to meet the functional needs, coverage benefits are applicable and available only for one DME that has the minimum specifications for patient requirements. They include:
- Standard power wheel chair vs custom wheel chair
- Standard bed vs semi electric bed vs complete electric or floating bed
- This limitation is particularly intended to eliminate coverage for deluxe or additional components for a DME item and is not much needed to meet the minimal specifications of patients to treat the chronic disease or illness.
- When a patient buys or rents a DME exceeding the above guideline, patient is responsible for the cost difference between the items or devices purchased or rented.
- The DME billing services excluded from coverage includes:
- Accessories or devices those are included to DME services are primarily meant for patient’s comfort and convenience. So, those DME devices won’t be covered by insurance companies.
- Air conditioners
- Air purifiers and filters
- Batteries for non-medical equipment
- Humidifiers
- Non-medical mobility devices. This exclusion does not apply for Pediatric DME billing coverage.
- Remodeling, modification of DME to home or vehicle to accommodate DME or patient condition.
- Dental braces. Patients must check specific dental benefit plans and State regulations for this DME coverage.
- Cranial molding helmets and cranial banding unless it prevents the need for the surgery and facilitate for successful surgical progress.
- Devices and computers those assist and aid in communication and speech of the patient.
- Diagnostic or monitoring DME bought for using at home unless prescribed by healthcare professionals.
- Oral appliances for snoring.
- Orthodontic braces to straighten and change the shape of patient’s body.
- Powered and non-powered exoskeleton devices.
Covered DME Billing Services:
- DME services or healthcare services that include supplies or pharmaceutical products to determine the following:
- DME provided for the sake of preventing, evaluating, diagnosing and treatment of a chronic disease or illness, injury, mental illness, addictive disorders.
- DME that’s medically necessary.
- Not excluded and described under covered services.
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