DME Billing Services – What To Expect In 2022?

The impact of the COVID-19 continued with the implementation of the new round of Medicare’s Competitive Bidding Program. In fact, the year 2021 has witnessed numerous acquisitions and mergers like never before just to overcome these hurdles of the pandemic. Not only this, the numerous industries including the medical sector continued to be plagued with compliance concerns. All this has also impacted the Durable Medical Equipment (DME) billing services. Undoubtedly, constant changes in regulatory compliance have already made it hard for the DME providers to stay up to date. On the other hand, the year 2022 will see such more additions and changes in the DME medical billing and coding system.

Hence it is better to stay updated about the changes that can be expected for better patient services. It will also ensure that mistakes are being avoided while making the DME billing and coding process cost-effective.

Continuous Glucose Monitors

The Centres for Medicare & Medicaid Services (CMS) issued a rule to be implemented from February 28, 2022. It has classified non-implantable continuous glucose monitors (CGMs) as DME. This regulation is made irrespective of whether the FDA approves CMG to replace the blood glucose monitor used in deciding for diabetes treatment or not.

In fact, any CGMs that are not replacing the blood glucose monitor will be viewed as adjunct DMEs and needs to be billed for. These can be used to check the trend in the patient’s glucose level even when they are asleep. In addition, it can be used to identify the potentially dangerous level of glucose in the patient.

Change in Codes & Modifier for CGM Receivers

The HSPCS codes and the modifier combination used to bill rental insulin pumps used as non-adjunctive CGM receivers have changed. In addition, the changes are different for claims as per the service date. For example, the codes of February 28, 2022, and March 31, 2022, are different from the claims dated on and after April 1, 2022.

There is also change in the billing for the beneficiary and their coverage. For instance, until the insulin pump, or CGM, is used for five years or expires, the new regulation won’t cover it.

Undoubtedly, these are just two changes for CGM receivers. There are many more in place or expected to occur, such as full force investigation on targeting the illegal telemedicine prescribers. As a result, it is helpful to be prepared and follow some strategies for 2022 to warrant efficient DME billing.

Strategies to Follow In 2022 for Effective DME Billing  

Since changes in DME are evident, it is better to have some strategies in place to cope with such changes. So here are the top 5 strategies you can follow.

Understand the Changes and the Process

The DME billing is quite different from other medical billing and coding services. Firstly, it is quite time-consuming and needs to be done with the proper paperwork that involves the doctors, DME suppliers, and the insurers. Hence proper DME billing and coding needs to be done for which the patient’s prescription is a must, along with the patient’s insurance policy and billing information.

At times pre-authorization can also be needed by the patient to go through the claim. Moreover, one needs to consider that the insurance company will verify the diagnosis and treatment before approving the equipment and the billing. Hence every step needs to be understood and stay updated with the changes to warrant the claim is successful.

Validating the Insurance

Validating the insurance by either calling them and knowing the detail about the patient’s coverage or using EMR for verification before the scheduled appointment will give you the time to understand the information on the patient’s policy. In addition, it will allow you to know whether the insurance covers the equipment, thus preventing late or no payment.

Collecting Upfront

Validating the insurance beforehand will also allow you to collect the amount if there are any co-payment or co-insurance clauses. There is a need to put in place an efficient check-out process while the patients are on-premises. It must also include checking any deductibles and past dues timely.

Correct Coding

In order to ensure accurate and timely DME billing and claim management, you should not emphasize only on above strategies. You have to ensure that every piece of equipment and accessory is coded and billed correctly for the claim to be successful with the insurer. Therefore, every staff handling the DME coding must keep track of the ICD-10-CM, HSPCS, and CPT-4 coding.

Better AR Management

Apart from ensuring proper documentation and staying at the top of the regulatory changes, effective AR management is the other way to ensure a higher DME revenue cycle with all the changes.

It is essential to update the system with the latest AR applications equipped with the changes for the healthcare industry. Also, it must be updated depending on the EMR recorded for patient’s data, follow-ups, reimbursements, and claims. Therefore, this process will help in automation for the collection and simplifying the DME billing and coding system.

How to Ensure you are Equipped for the Changes?

DME billing and coding requires an in-depth understanding of the process and keeping up to date with the constant changes, follow-ups, and other claim management issues. Therefore, one of the best ways to move forward with claims is to outsource DME billing services. At 24/7 Medical Billing Services, the entire team of experts keep themselves updated with all the changes, regulations and rules to assure that the A/R collection is processed and managed efficiently. While you take care of your patients, outsourced DME billing and coding experts will ensure you get the reimbursements without any rejection.

Read more: How To Increase Profits For Your DME Store?

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