Know Your DME Billing Process Well

DME Billing is a bit different if seen along with the other genres of medical billing. A Durable Medical Equipment (DME) provides therapeutic benefits to patients suffering from certain medical conditions and/or illnesses. A DME is built to serve a medical purpose with the ability to withstand regular use, appropriate for using it in the home. Regular DME items include:

• Wheelchairs
• Orthotics
• Slings
• Crutches
• Cranes
• Compression sleeves

However, it is surprising that despite the importance, DME billing has a lot of uncertainty surrounding it. It is really unfortunate that despite DME providers getting sufficient physician orders for supplies, quite often they struggle to recover the expected revenue.

Different DME companies have different DME billing styles depending on the frequency. Some companies bill regularly as and when required while several others bill a few numbers of times through the year. DME billing needs to be extremely meticulous and accurate as a single mistake in the billing of just one medical device can bring a loss of thousands of dollars for a DME seller.

To work on the loopholes of DME billing of provider/seller, we need to understand the DME billing process.

DME Billing Process: A Brief Overview

Here are the key components of a typical DME billing process:

Prescription:
The primary requirement for DME billing is a prescription from the ordering physician for rent/ purchase mentioning with the quantity of the DME mentioned.

Verification:
Verification of the demographics and other patient data before filing for claims.

Credentials:
When DME-suppliers bill they need to meet the credentialing criteria before applying for reimbursement. Note: The billing for DME providers is sent to the DME carrier and not to Medicare Part B carrier. However, an exception is the covered cast supplies.

Form:
The CMS-1500 is the designated form for process a bill electronically.

Documentation:
Completion of documentation with physician’s treatment plan needs to be ensured, along with the time frame for the DME usage.

Codes and Modifiers:
It’s very important to apply the appropriate HCPCS codes, procedure codes, maintenance, and repair modifier codes. In the absence of an apt code, the E1399 or other HCPCS codes can be used. Note: A denial can result in case HCPCS is used before the expiry of a product lifetime (1-3 years generally).

Factory Invoice:
A physical invoice (not electronically sent) must be attached containing the complete description of the item along with the medical necessity form signed by the physician. Note: All the initial documents must be enclosed in one envelope and then get submitted. The electronic processing cannot be commenced before this.

Dates:
The Date of Injury (DOI) must be mentioned clearly. If required, mention the Date of Service (DOS), which is the day the patient died or the day the patient stopped using the DME. Note: The date of service is the date the patient receives the equipment. It is not the date of shipping to be precise. The only exception is a patient’s cancellation of the order where the date of service becomes the date the equipment order is canceled.

Supporting Documents:
Attach the documents to support the necessity of the product, like chart notes, surgery notes, LMN/CMN, product description, etc.

Coverage:
The coverage starts on the day the apparatus is delivered, setup/installed, and ready for the patient’s use of the place desired (usually home) or at a skilled nursing facility.

Repairs claim:
Bill any claims for repair with an entire explanation of the services.