In order to survive 2019 and get timely payments, DME providers will have to primarily focus on error-free coding. DME coding intricacies are deep rooted in HCPCS (Healthcare Common Procedure Coding System) Level II codes and policies by Medicare. Providers will have to hire DME coders who are experts at assigning the right HCPCS Level II codes for timely and error-free billing. They will have to have a good understanding of Medicare policies related to DME. Even the physicians will have to get a good understanding of their vital role in getting reimbursed for rendered services.
Focus on providing the right documentation
Each time coders will be using a HCPCS Level II code that ends in 99 (for instance E1399), they will have to provide supporting documentation with it. This is important because if Medicare receives a miscellaneous code, the claim gets suspended and concerning medical records are requested. These records are then checked for possible issues. The miscellaneous code is also reviewed to see if there is any other code that is more apt for the billing process.
So, DME billing demands top-notch coding because only experienced coders are aware of the appointed codes for most DME items.
There will be a strong need to establish medical necessity of a DME device within the treatment episode. For instance, if a physician is ordering a wheelchair for a patient, it will be necessary to support it as a medical necessity. There are certain policies known as LCDs (Local Coverage Determinations) that are used for addressing necessary equipment usage. Knowledge of these policies will be needed so that the billers can avoid denials and receive proper reimbursement.
Streamlined billing service will remain a necessity in 2019 as well because obtaining reimbursement for DME is quite complicated. There are various reasons for this. For instance, from the DME reimbursement standpoint, if the reimbursement doesn’t form a complete treatment episode and just a part of it, the necessity of the treatment episode will depend on the recommendation of the physician. Due to this dependency, reimbursement for DME incidents gets complicated, requiring additional paperwork.
To get timely payments, DME billers will have to handle DME documentation effectively. They will have to have the expertise to handle reimbursement administrative activities starting from the identification of instances eligible for payment to claims preparation and submission.