DME billing is complex in nature- this is something that almost all practices dealing with durable medical equipment will agree with. Quite often, providers get substantial orders for supplies but they fail to recover the expected revenue due to inexperienced billing staff and their inability to work around an effective DME revenue process.
Error-free billing for durable medical equipment is critical because even if one medical device is billed incorrectly, it will result in a loss of thousands of dollars. Also, unlike most clinical procedures, DME billing suffers from various challenges. For instance, DMEs are mostly ancillary services and are often deemed as medically unnecessary. Also, at times, prescribed DME doesn’t meet the permitted reimbursement level and if there is a lack of HCPCS (Healthcare Common Procedure Coding System), then also timely payments become a challenge.
With the rise in the number of aging patients, market for durable medical equipment is expanding. It is also growing because patients now desire to stay in their homes. It is expected that the global durable medical equipment market will display growth by a CAGR of 6.14% during 2018-2023. But if effective billing practices are not in place, then getting paid will become a challenge.
Since DME billing has also been hit by regulatory changes such as the Final Rule, having a team of expert billers and coders has become a necessity. CMS has made it necessary to establish a prior authorization process for some orthotics, DMEs, prosthetics, and supplies under this rule. Now practice managers have to build a proper prior authorization process which is quite time-consuming. Complications involved in the creation of this process affect revenue generation and billing in a negative manner.
Considering the challenges 2018 is posing for DME billing, seeking support from a professional billing company is the only hope. From navigating through difficulties in insurance approvals and permissible level of reimbursement to HCPCS, a reliable billing company will have the expertise and experience to help practices fight common DME billing challenges.
To maintain a steady cash flow, it is necessary to have an expert team that handles audits, claims submission, follow-ups and so on. By hiring a reliable billing partner, DME billing setbacks can be dealt with ease and billing costs can be reduced by 80%. Billing companies also ensure 100% HIPAA compliance along with offering monthly customized reports.