What are the Best Ways to Overcome the Complexities?
Durable medical equipment (DME) billing is among the most challenging medical billing and coding aspects. DME refers to equipment that provides therapeutic benefits to patients with certain medical conditions or illnesses at home or in any non-hospital setting. DME includes wheelchairs, oxygen tanks, nebulizers, CPAP machines, prosthetics, orthotics, and more.
DME billing is complex for several reasons. First, it requires high documentation and compliance with various rules and regulations. DME service providers should be aware of all the requirements. For instance, they must obtain a valid prescription from the patient's physician, a certificate of medical necessity (CMN), and a detailed written order (DWO) specifying the equipment's type, quantity, frequency, and duration of use.
Second, DME providers, such as Medicare, Medicaid, and private insurers, must follow different payers' coverage criteria and guidelines. Each payer may have different requirements for prior authorization, modifiers, codes, and reimbursement rates. Medical policies are frequently changed or updated, so it is essential to keep abreast of them to comply and avoid denials.
Third, DME billing involves using different medical codes: Durable Medical Equipment Coding System (DMECS), HCPCS (Healthcare Common Procedure Coding System), Level II codes, and modifiers. Medical coding plays an essential role in DME billing. It has been identified as one of the primary sources of errors in the billing process. Thus, DME billers and coders must be trained on how and when to use these codes. Incorrect use of medical codes would reflect an inaccurate service.
Due to the complexity and variability of DME billing, it is easy to make mistakes or overlook details that can result in claim rejections or denials. The constant evolution of compliance regulations and requirements makes DME billing challenging. Billing errors can cost DME providers a lot of money, especially if they occur regularly. Thus, it is crucial to take concrete measures to prevent these mistakes.
So, how can DME providers overcome these complexities and ensure accurate and timely reimbursement for their services?
1. Form a quality control team
DME billing constantly evolves due to new technologies, regulations, policies, and market demands. DME providers should keep informed of any changes affecting their billing practices and adjust accordingly. An efficient way to do this is to form a dedicated quality control team to keep abreast of all changes. This group will ensure compliance with policy modifications and necessary documentation.
2. Educate the staff and patients on DME billing and reimbursement
DME providers should train their staff to properly document, code, bill, and collect payments for DME items. They should also educate their patients on their rights and responsibilities regarding DME coverage and copayments.
3. Outsource DME billing to reputable DME billing services
The acquisition and maintenance of a DME billing system and skills training for the DME billing team can be costly. A better and more cost-efficient option to reduce DME billing errors would be to outsource the process to a group of experts such as Proclaim Billing Services. A reputable DME billing company can leverage its expertise and experience to ensure compliance with payer rules and regulations, reduce errors and denials, increase reimbursements, and save time and money for the provider.
Why Partner with Proclaim Billing Services?
Proclaim Billing Services is the leading DME, Prosthetic, and Orthotic billing expert with years of practical experience applying business processes. Hiring the team will be your best choice if you are a DME healthcare provider looking for experience and expertise in managing your Accounts Receivable, Collections, and Claims Processes. Entrusting your DME billing process to Proclaim Billing Services will significantly reduce billing errors, claims denials, and rejections and reduce your workload, allowing you to focus on caring for your patients.
Set an appointment today to learn more about how Proclaim Billing Services can assist your practice.