Durable medical equipment (DME) is prescribed by medical practitioners that provide therapeutic benefits to a patient with specific medical conditions. To render DME items suitable for reimbursement, it is essential that their suppliers meet the eligibility criteria or requirements set forth by BluecrossNC. There are specific sets of guidelines dictated by BluecrossNC that classify this equipment into three categories that are “inexpensive”/ “other routinely purchased”/ “routinely purchased” DMEs. These categories are critical to be factored in during a DME billing process.

Our medical practitioners have experience in handling medical billing and coding services, how difficult will it be for them to handle DME billing process?

The DME billing process is different from the other types of medical billing and coding processes. Unlike the regular coding processes, DME equipment is classified under HCPCS level II codes. These codes are 5 digits long and are a combination of alphabets and numbers. Thereby adhering to these complicated codes while conducting the DME billing process requires domain-specific expertise. The DME billing process entails multiple steps starting from getting a prescription from a medical practitioner, assigning the appropriate codes and processing a billing claim to the patient’s insurance company, and then proceed with its distribution to the patient.

In light of the Covid 19 pandemic, governing authorities floated across a barrage of new rules and regulations to ease access and affordability of medical equipment. This added to the overall complexity of this process which is why it is prudent to outsource DME billing to third party vendors who have the requisite knowledge and stay updated with the dynamics of the overall medical coding and billing processes.

What are the Regulations that can Possibly Impact the DME Medical Billing Process in 2021?

Responding to the medical emergency created by the Covid 19 pandemic outbreak, the Centers for Medicare & Medicaid Services updated its rules in April 2020 that governed emergency waivers and pertinent to Medicaid and Medicare policies. While these governing rules equipped the American healthcare system with the requisite flexibility to respond to the pandemic, it impacted DME suppliers in certain ways. Suppliers are functional in executing the claims submitting process and getting authorizations which are the integral parts of a DME billing process. Thereby the regulations affecting suppliers had a consequent impact on the overall process which reinstate the necessity to outsource DME billing process to external experts.

Here’s a look at some of the waivers that will impact the DME billing process in 2021.

  • Requirements such as physical interaction, recommendation from physicians stating medical necessity of DME equipment for the payment of a DME replacement item is waived. However, DME suppliers are required to provide a proper description of the replacement claim and should properly document the equipment damage or loss. This brings certain changes and demand time for suppliers to complete the procedures which ultimately impacts the regular DME billing process.
  • The new regulations negated the need of patient signatures and proof-of-delivery notes to abide by the no-contact policy in the ongoing pandemic situation. Instead, suppliers are required to note the correct DME equipment delivery date and state the inability to derive patient signature owing to the Covid 19 pandemic. This adds to the steps normally followed by a DME supplier, thereby creating ripples in the generic DME billing procedure.
  • Under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, CMS will make higher payments for specific DME equipment in areas classified as non-rural and non-competitive bidding areas within the US throughout the Covid 19 led emergency period.

What are the right moves to make to outsource DME billing in 2021?

To look at the brighter side, the unique and the precarious situation set forth by the Covid 19 pandemic has gradually cleared the dilemma that surrounded the question whether to outsource DME medical billing or to rely on in-house expertise. In-depth knowledge about Medicare, Medicaid, out of pay and other industry mandates not enough to boast about your expertise on DME billing. The changing regulations and dynamics in the healthcare sector this year will necessitate special expertise in the DME billing process in 2021.

Here’s a look at the factors that will help you take the right decisions pertaining to DME billing in 2021:

Robust Technology Infrastructure An immediate Rx for the extreme dynamism witnessed in the overall medical billing process is to place your faith on the latest technological innovations that can speed up the DME billing process. This compensates for the additional time taken to align the billing process to the current regulatory framework. However, to expect a healthcare institution to invest and then train its employees on the new technologies will be an added burden considering the Covid-19 emergency care they are providing to the ailing. Thereby, it is even more relevant in 2021 to outsource DME billing process to vendors who have the necessary technology infrastructure and expertise for a flawless execution of the process.

In-depth Knowledge in Coding Process A prospective vendor must have a solid background in the Healthcare Common Procedure Coding System (HCPCS), overseeing level II codes that are assigned for DME supplies and equipment. Inappropriate application of the seventh figure for trauma and fracture codes, incorrect procedure codes usages are some of the quality red flags that a qualified DME billing expert must not exhibit. Improper usage of codes results to claims denials which is a huge setback for the prospects of revenue generation of an organization.

Redundancy plans in placeUncertainties will continue to cloud the healthcare administration management. Enterprises will face shortage of labor which will jeopardize the possibility of a prompt and accurate execution of DME billing process. In such a scenario, it is imperative that enterprises ascertain the usage of redundancy plans by DME billing service providers. Providers with an eye on the future will leverage redundancy plans for a timely execution of DME billing processes such as eligibility assessment, authorization, AR collections, and denial management.

Robust reporting As a response to the Covid 19 emergency, a majority of hospitals in the US suspended their non-emergency care that resulted in over USD200 bn losses over a period of four months according to estimations done by AHA1. Stepping into 2021, it is imperative for healthcare enterprises to partner with DME billing service providers who can help in reducing the overall operational expenses. An experienced partner is expected to provide accurate reporting which uncovers areas of improvement in the DME billing process that helps to reduce billing errors, thereby increasing prospects of saving costs by getting the job on one go.

Who are we and Why should you Trust out on our Proficiency?

This article is penned by industry veterans at MedbillingExperts. With the motto of driving maximum reimbursements in minimum time, we have provided offshore DME billing services to a range of clients based in the US. We are certified by Medicare to bill all Certificates of Medical Necessity and leverage a well defined DME billing process flow to offer almost 100% accurate patient entry and sales order creation. We provide follow-up services on partial pays, incorrect pays, and rejections within a day. We ensure CPAP user compliance tracking and initiate counselling calls to non-compliant patients.


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