DME Medical Billing – Claims, Reimbursement, and More

The most surprising fact about the complex subject of DME medical billing is, even after Durable medical equipment (DME) providers get enough numbers of physician orders for supplies, they have to struggle to recover the expected revenue.

The strange phenomenon is due to the uncertainty that surrounds the DME claim reimbursement process. There are different ways that different DME companies follow to bill their DMEs. The difference is generally on the time/period basis – while some companies bill a few times through the year, others do it in continuous regularity. Whatever process they follow, DME medical billing calls for best of accuracy and precision. Committing a billing mistake for just one medical device can result in a loss of thousands of dollars.

The checkpoint watch begins immediately after coming to know that the patient needs a precertification from the insurance company before the product is set to get dispersed. Often the insurance companies deny claims if they find that even if a single piece of DME needing precertification has not obtained it. The apparent time-consuming process of precertification prior to medical billing actually saves a lot of money in the long run.

The distinct difference of DME medical billing from billing for other medical and clinical procedures lies in the fact that DMEs are predominantly considered ancillary services and the requisites are often deemed medically unnecessary. The physician’s recommendation in such cases becomes the strongest weapon to fight the case. The providers need to ensure the order from the physician prior to bill the DME. In complex cases, a signed certification is more useful than a formal order for a proper medical billing. Proper charting of the medical necessity is also an important condition along with the date of the original order.

DME Medical Billing – Some Important Points

For medical billing professionals and healthcare workers, it is very important to know that the date of service has a major significance in DME billing. Here are a few pointers on the date of service:

• The patient receives the equipment on the date of service and notably, not on the date of shipping.
• However, if a patient cancels the order, the date of service becomes the date the equipment order has been cancelled.

A lot of specific rules are involved in billing for DME. A medical billing professional must be aware of the specific nuances of the equipment to bill DMEs. We have just discussed a few general tips that can keep a DME medical biller prepared and ready. DME billing is a huge subject, which goes much beyond the few tips, outsourcing to a reliable professional medical billing company can help the DME sellers or healthcare providers in the best possible way.

John is an account manager working in a leading DME Billing services provider located in New York.