Durable Medical Equipment billing is an industry with ever-changing payor policies,
reimbursement regulations, and compliance. You can succeed in this constantly changing
industry by having a solid understanding of:
DME billing processes
How it differs from other medical billing procedures
Some critical components to the industry
Understanding claims audits
What are DME and DMEPOS?
Durable Medical Equipment, or DME, is medical equipment that helps a person with daily life at
home (or non-hospital setting). DMEPOS items include the same DME medical equipment along
with Prosthetics, Orthotics, and Supplies items. A DMEPOS item usually is used repeatedly, lasts
3+ years, and serves a medical purpose.
DMEPOS items include:
Artificial limbs
Crutches
CPAP machines and equipment
Hospital beds
Orthotics (i.e., neck braces)
Prosthetic devices
Various medical supplies
Walkers
Wheelchairs and accessories
And more
What Is DME Billing?
DME billing is the process of submitting and receiving payment for a claim from the insurance
company. Implementing, maintaining, and educating staff on proper billing is vital to a DME
provider’s success. Staying up to date on industry guidelines and compliance is critical to
ensure clean claims are submitted and you receive timely payments.
How is DME Billing Different from Other Medical Billing?
DME billing has two main components; it allows for rentals and requires HCPCS (Healthcare
Common Procedure Coding System) codes. When submitting insurance claims, HCPCS helps to
identify the billed item or service provided. For instance, HCPCS code E0607 represents a home
blood glucose monitor.
5 Things That Will Help You to Better Understand DME Billing
DME billing is a complex and ever-changing industry that requires constant learning and a
successful billing process to ensure timely paid claims. Here are five things that can help you to
understand the complex world of DME billing better.
#1 How to Bill DME?
You will need to create and maintain a thorough and efficient billing process from intake to
claims submission. A proper billing process will have a positive ripple effect throughout the
company and help providers receive the maximum reimbursement available.
#2 DME Billing Guidelines
DME payor medical policies often change across the various product lines. Make sure to have a
system in place to stay current on all changes before submitting a claim. Regularly checking
the CMS’s website is an efficient way to keep up to date on all Medicare and Medicaid DME
guidelines.
#3 DME Billing Specialist
A DME billing specialist’s goal is to ensure all submitted claims are accurate and contain all the
required paperwork to reduce the number of rejected claims. They have several
responsibilities, including ensuring compliance with payors guidelines, checking and correcting
HCPCS codes, submitting and following up on claims, and more.
#4 DME Billing Services
Outsourcing DME billing services can provide you access to DME billing specialists. Those
specialists can process claims, check on claim status, stay current on all payor guidelines, and
more. Outsourcing billing services can free up extra time to be sent on marketing or bringing in
new business.
It’s important to note that no DME billing company and its billing services are the same, so
make sure to gather all the needed information to make an educated choice before selecting
the best one.
#5 DME Billing Companies
Outsourcing to a DME billing company can help you stay current on policy changes and alleviate
some time-consuming medical billing tasks. Finding and working with a trusted and reputable
DME billing service, like , can increase timely paid claims and reduce the amount of rejected
claims.
Select a company that’s more than just a claims submission service. A DME billing company, like
, can become an extension of your billing department and can provide you with numerous
services from A/R to audit assistance to revenue cycle management.
Medicare DME Claims Audits
Medicare DME claims audits help to ensure all claims submitted are accurate and correctly
paid. If you receive an audit request, make sure you respond by the deadline, send all the
requested documents, and begin reviewing the audited claim internally.
There are several types of Medicare DME audits, including:
Comprehensive Error Rate Testing (CERT) Audit
Medicare Administrative Contractors (MACs) Audits
Recovery Audit Contractor (RAC)
Unified Program Integrity Contractors (UPIC) Audit
It’s important to note that each insurance payor will have their own auditing entity as well.
Tips on Minimizing Claims Errors
Develop and maintain an audit ready process to minimize potential claim errors. Here are five
tips to get you started:
1. Review your current claims process (from intake to submission)
2. Review your denial rates and reasons
3. Audit yourself and look for potential errors
4. Analyze and make any necessary changes
5. Repeat regularly
Navigating the DME Billing Industry
After reading the above information, it’s clear that DME billing is an extensive industry that is
regularly inspected, audited, and ever-changing. Investing time and resources to develop a
billing process, properly training staff, and promoting a culture that encourages learning is
needed to stay current.
Sometimes additional support, through outsourcing, can help to reduce the time-consuming
tasks. Outsourcing provides extra time and staff for other business matters (marketing,
increasing sales, etc.) Finding a trusted DME billing company to help with your DME medical
billing needs can make all the difference.
Things to Consider When Reviewing a DME Billing Company
Keep these questions in mind during your DME billing company search.
What is the document review process?
Are claim denials reviewed and managed?
Will they look for claims rejection trends to better improve the billing process?
Is personalized support an option?
Will my staff be educated to increase future successful billing practices?
Do they stay up to date on changes to payor policies?
Will they review my A/R process and offer improvements?
How to Know if DME Outsourcing is Rig
