DME Billing for Medicare Part B

With old age, assistance and assistive equipment become essential to help us do things that were natural to us once—for instance, a walker to move and walk around easily without a nurse. But for many older people, the world of insurance and vendors can be pretty overwhelming, mainly when it comes to purchasing Durable Medical Equipment (DME).

But the challenges of navigating the world of DME are not only for the end-users, i.e., the patients, but also for the DME service providers. The facility is different from any other services in the medical field, which makes DME billing and coding more challenging.

Since DME is given to patients to avail of the therapeutic benefits for certain health conditions or diseases, it is also used at the home, hospital, or other healthcare units regularly by the patients in many cases.

What are Standard DME Products?

Within the standard DME products, there are two parts, Part A and Part B, which include:

  • Cranes
  • Orthotics
  • Pressure Sleeves
  • Slings
  • Supports
  • Wheelchair

Despite becoming an essential requirement for the increasing aged population, DME billing is shrouded with lots of uncertainty. As a result, many DME service providers, despite having the proper doctor prescriptions for the services many DMEs struggle to reimburse the money for the services rendered.

Details about DME Billing for Medicare Part B

As mentioned earlier, DME billing is categorized into two parts, Part A and Part B. In Part B, there are certain restrictions on the coverage of medical supplies. The section offers the benefit of equipment to the patients medically necessary as prescribed by the physician. The equipment can be used at home, but the supply has to be prescribed and purchased from providers who belong to the Medicare program to get the benefit. Furthermore, the supplier also needs to accept and adhere to the DME Medicate regulations.

In most cases, for the Part B benefit plan, the patient has to pay 20% of the allocated amount under the Medicare allowance for the DME. But before that, the patient needs to meet the Part B applicable deductible amounts. 

It is also important to note that the DME supplies or equipment can be subjected to competitive bidding in some regions of the country where a patient resides. Medicare introduces the process as part of a cost-saving initiative. It helps the healthcare costs align with the item’s actual purchasing price. If a patient has Medicare coverage that stands under the bidding program for DME, they must use a supplier contracted with the Medicare program. Failure to do so will result in the patient not getting the benefit from Medicare.

Which DME are included in Medicare Part B Plan?

Here is a list of the supplies and equipment that falls under Medicare Part B and can be reimbursed.

  • Commode chairs
  • Continuous Positive Airway Pressure (CPAP) along with its devices and related supplies to
  • equipment and supplies for Enteral nutrient
  • Hospital beds and their accessories
  • Standard nebulizer and its related supplies
  • Negative Pressure Wound Therapy (NPWT) along with pumps and related supplies
  • Oxygen, its equipment, and other related supplies
  • Patient Lifts
  • Seat lifts
  • Walkers
  • Wheelchair and its accessories for both manual and standard power
  • RADs (Respiratory assistant devices and the related supplies
  • Mobility scooter and the related accessories
  • Group 1 and Group 2 support surfaces
  • TENS (Transcutaneous Electrical Nerve Stimulation) devices
  • Diabetes testing supplies (mail-order only)

How is the DME Billing Done?

DME service providers should be extra careful and succinct with the DME billing and coding, regardless of whether they charge regularly or twice a year. A single error will lead to the loss of thousands of dollars for the service provider.

It has been observed that several DME organizations charge consistently across the financial year, and some facilities charge only a few times every year. While doctors might recommend a patient find a DME provider in their region, patients can choose a DME supplier of their preference.

What should DME do to Provide the Equipment?

Whether the DME equipment falls under Part A or Part B category, the DME suppliers should adhere to specific activities when providing the equipment to the patients. Some of them are:

  • Ensure proper and legitimate delivery of the equipment and setting it up for the patient
  • Check and ensure that the condition of the facility, e.g., home, hospital, clinic, or nursing home, is sheltered and has the optimum condition to warrant the best possible use of the equipment.
  • Train the patient, family, or caregiver to operate and use the equipment in the best possible way and upkeep it.
  • Giving the patient or the caregiver the necessary information on the usage and maintenance of the equipment.

All of these- all the DME suppliers and service providers have to give consent to the HIPPA (Health Insurance Portability and Accountability Act) to ensure all the documents and records of the patients are secured and cannot be accessed without the proper authorization.

How can DMEs with Part B Plan ensure Correct Billing?

The discussion on how DMEs lose money due to incorrect DME coding, adding modifiers, or failing to provide the required document has been a hot topic in the healthcare industry. Often the facility fails to give the necessary documents to support the equipment requirement, resulting in claim denials or rejections. While the DME service provider also has to check whether the patient is covered by Plan B to get the money, it becomes challenging to scrutinize every detail.

24/7 Medical Billing Services, your outsourced DME billing partner is your best choice for such an instance. As a DME billing and coding service provider, we ensure that the patient is covered by Plan B for DME and also follow up with the payers to ensure you do not lose the revenue. Our specialized DME billing experts provide support to all DME facilities with their billing and coding process and better RCM to warrant an improved ROI and better scalability.

Read more: 7 Most Common DME Billing Challenges

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