The DME Billing Process in Brief

Author: John William

DME Billing does not match with other segments of medical billing. Durable Medical Equipments (DMEs) are usually prescribed for therapeutic benefits to patients suffering from specific medical conditions and/or diseases. A DME is designed to meet the medical purpose with withstanding ability of regular usage, especially at home. Regular items of DME include:

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

However, surprisingly, the importance of DME is often undermined and thus DME billing faces a lot of uncertainty due to that reason. Can you imagine that despite getting sufficient physician orders for supplies, DME providers often can’t recover the expected revenue? Strange but true!

Different DME companies work in different billing styles, based on the billing frequency. Some bill regularly as per requirements while others bill throughout the year but a lesser number of times. DME billers need to be extremely careful and work with accuracy. A single mistake in the billing of just one DME can bring catastrophe – the DME seller can incur a loss of thousands of dollars.

An understanding of DME billing process helps to work on the loopholes of DME billing of your practice.

The key components of a regular DME billing process are as follow:

  1. Prescription: The prescription from the ordering physician either for rent or purchase mentioning the quantity of the DME mentioned.
  2. Verification: Verification of demographics and other patient data is needed prior to filing of claims.
  3. Credentials: DME-suppliers need to meet the credentialing criteria before applying for reimbursement for billing.
  4. Form: The CMS-1500 is the designated form for an electronically processed billing.
  5. Documentation: Completing documentation with physician’s treatment plan is mandatory including the time frame for the DME usage.
  6. Codes and Modifiers: Proper HCPCS codes, procedure codes, maintenance, and repair modifier codes are required.
  7. Factory Invoice: A non-electronic, physical invoice is to be attached that contains the complete description of the item. The medical necessity form signed by the physician has to be included.
  8. Dates: The Date of Injury (DOI) must be mentioned with clarity. Mention the Date of Service (DOS) if needed, which is the day the patient died/stopped using the DME.
  9. Supporting Documents: Attach supporting documents like chart notes, surgery notes, product description, LMN/CMN, etc.
  10. Coverage: The coverage starts on the day the apparatus gets delivered, setup/installed, and is ready for the patient’s use at the desired place (usually home) of delivery or at a skilled nursing facility.
  11. Repairs claims: Bill claims for repair with the appropriate explanation of the services.

These tips can help you in understanding DME billing better. However, a professional DME billing service will always the best option for you to fix your billing woes.