Billing & Coding Guidelines for DME Billing Services in 2022

DME Medical Billing or Durable Medical Equipment billing is rather different from any other medical billing and coding. Just like any other billers and coders working with DME need special training to deal with various other medical situations and equipment that need different types of modifiers as requested. DME billers need to have a specialized detailed, specialized knowledge of different types of HCPCS Level 2 codes.

Sounds too complex?

24/7 Medical Billing Services make it easier for you.

Here’s a complete guide to DME medical billing and coding in 2022 and beyond.

DME has its own critical part of handling revenue cycle management. It is filled with strict credit markets, tight regulatory scrutiny, and ever-changing operational requirements. As DME medical billing has an impact on medical insurance reimbursements, investors, practitioners, and sales teams are always on the lookout for robust DME billing models focused on operational improvements to improve profitability, liquidity, and investing resources.

Top DME Challenges that we Navigated for our Clients

  • Coding Errors
  • Erroneous Document Management
  • Regulatory Challenges
  • AR Management and Denials

Let us picture for you how medical billing and coding work for DME suppliers and distributors

  • Identify the Need the Durable Medical Equipment
  • An in-depth Written Order or Prescription completely signed by the referring/rendering/servicing provider must be on file
  • Study the provider’s treatment plan
  • If this is shown by accident or injury related case, mention the date of the incident
  • Credentialing
  • Is physician practice billing for the DME? (Medicare requires that you have completed and been approved. Check the form CMS-855s.)
  • You can be a vendor or provider out of the network from the commercial insurance (except Medicare) but you need to be careful that you have let your patient know that you are out of network provider. Inform the patient about their estimated out of network payables.
  • Ensure you have checked the patient’s benefits and if he/she is eligible for the particular DME.
  • Watch for its usage policy and guideline. For instance, Medicare Beneficiaries cannot get the exact similar Lumbar Orthosis in the 5 years
  • Check for medical necessity diagnosis cross over
  • Make sure you have understood the difference between billing out of network and in network
  • Making sure that you are reporting the correct HCPCS codes to describe the DME or Durable Medical Equipment
  • Making sure you are reporting the right place of service and correct DME Billing services modifier(s)
  • Making sure that your date of the bill for service is the date you have dispensed the DME or Durable Medical Equipment to the beneficiary and also that same day the patient has signed receipt of the DME. We have solutions for you to appropriately bill the patient.
  • If the service date is for a rental and is in the range of dates, ensure that you verify with your insurance payers how they are reporting it. Here are some examples:
  • Is one-month rental equals to 21 days or 30 days?
  • Are you reporting it from start to end date and report the number of units in days?
  • Are you reporting the exact date of service for start and end date?
  • Get a copy of your patient’s signed receipt confirming that they have received the DME service
  • Document the necessity of durable medical equipment.

At 24/7 Medical Billing Services, we have served more than 20 DME providers handling their medical billing and coding on their own.

We have more case studies to present to you if you are interested in hiring a trusted partner in DME billing and coding.

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