DME – Durable Medical Equipment Billing Services
Durable Medical Equipment (DME) reimbursement can be a tricky part for a physician to manage due to the requirement to prove the necessity for the DME, the differences in evidence depending on an individual’s circumstances, and the difficulties involved in medical billing codes. With all issues considered, many medical practices lose a large portion of money each year on administrative expenses and unpaid claims. Using a billing expert can help to achieve increased success with DME claims and to decrease the pressure on your staff to collect the adequate amount of evidence required to validate DME claims.
Effectiveness of Claims Submissions
Many claim denials occur when DME devices are claimed incorrectly, with the assumption that they will be covered. The issue with DME claims is that coverage is incidental and depends on the patient’s condition. For example, a walker required by an elderly patient in a permanent nursing facility may be reimbursed, however, the same type of walker used by a non-permanent resident who uses a one-off nursing facility would not be eligible in a claim for a DME device.
Experience with this type of claim handling and understanding the minute situational differences is vital for effective reimbursement. Without knowledge of DME devices, those are covered, practices often submit inappropriate claims, which turns in to a waste of your staff’s time.
Classification of DME
Equipment such as orthotics, back braces, vena flow pumps, and intermittent limb compression devices, are DMEs that may be recommended by providers to help with treatment, rather than forming a complete treatment episode. Proving the requirement for a DME device can be a complicated part, which can lead to an extra book-keeping to show their requirement for treatment due to the fact that the DME is only a component of the treatment process.
Utilizes a team of experienced experts, who have years of experience dealing with tricky DME classification situations, to help you increase your DME reimbursement. We can help facilitate the process by:
- Monitoring the process from the very beginning to the end of the medical episode.
- Reviewing CPT and DX codes to make sure they are supported.
- Putting the DX codes into the proper order and adding the correct modifiers that are needed to ensure payment.
- Helping to process documentation after physicians have established establishing the necessity for a DME device within a treatment episode.
- Helping to submit the required documentation to gain reimbursement after the physician has obtained the signed ABN/Waivers from the patients and scanned them in the patient’s chart.
For example, in a DME claim, we are coders will help to build a description of the patient’s treatment using a step-by-step process to ensure all documentation is gathered, including necessary evidence such as photographs and progress charts, as well as the patient’s ability to use the DME equipment.
Benefits of Outsourcing DME Billing to Stars Pro
- Over 96% clean-claim settlements
- Fast and Error-free billing
- Boost in revenue by up to 25%
The medical billing process is not an easy task, and staff often find it extremely difficult to stay on top of monitoring requirements and fee coding. By outsourcing your billing function to a responsible provider, coding specialists with clinical experience, and with up-to-date knowledge can help to improve the revenue cycle and alleviate the staff pressure of billing.
From accurate identification of eligible claims to simplifying the process to gather necessary documentation for DME claims, our team has a wealth of knowledge and experience to guide claims processing. This can lead to significant benefits for your practice including improved revenue, administrative cost-cutting, and allowing your practice to focus on what really matters: the delivery of care.
For more information on how outsourced billing solutions can help to benefit your practice, contact us online or call us at 732-523-4633.
Medical Coding – Additional part
Get Our Experts to Work for You!
One of our major differentiators is our skilled coding experts who have in-depth knowledge and hands-on experience in working with Medicare, HIPAA, and Medicaid regulations. Our team has a thorough understanding of procedural and diagnostic coding
Our skilled coding experts are proficient with:
- ICD-10, CPT, and HCPCS codes across different specialties
- Payer-specific medical coding requirements
- Governmental, regulatory, and insurance requirements
Our certified medical coders (CPC) keep themselves updated with continually-changing tendencies in the medical industry, especially in ICD-10, CPT, and HCPCS codes. We also stay current with the latest versions of medical coding software such as Encoder Pro and Flash Code.