Durable Medical Equipment (DME) is a therapeutic equipment used by patients to treat certain medical conditions particularly conditions that are long-term ones. The use of these equipment is prescribed by physicians. Some such equipment includes kidney machines, ventilators, nebulizers etc. Most of the times the equipment is used for an extended period and outside the precincts of provider settings. The equipment cannot be used beyond certain period at patient homes. This duration of use is determined by the physician. Any use beyond this pre-determined period is not billable.
The DME billing sector is evolving faster than one can imagine. This is because of ever-changing regulatory compliance. Most healthcare providers are struggling to keep up with the changing DME billing market. The fall out of this includes billing errors, declining collections and delay in collections. Yet another challenge is dealing with attrition. The direct fallout of attrition is slow down of operations. Also, the cost of training new employees, can be substantial. In this blog we look at the various issues that make DME billing so complex. Also, we look at some of the ways in which this complexity can be simplified.
Reasons for DME Billing Complexity
Policy Violations
DME billers and coders have to depend on Durable Medical Equipment Coding System (DMECS) to prepare DME bills. On top of this, they need to refer to HCPCS release. There are a number of modifiers that they need to refer too. Some of these include rental, first-month rental, initial claim, medical necessity documentation, extended usage and so on.
Every DME billing invoice should be in accordance with these rules. These rules keep changing with time. Therefore, keeping up with the changes makes DME billing complex. Any mistake is interpreted as a violation of the policy. This may happen due to lack of knowledge. However, it gets interpreted as policy violation. This makes it important to have experienced billers and an up-to-date knowledge acquiring process.
Coding Errors
Coding errors in DME billing come in different shades. Some of these include inappropriate usage of HCPCS codes, inaccurate use of seventh character for trauma and fracture diagnosis, insufficient documentation for use of devices, grafting materials, improper coding of guidance tools, inaccurate patient data etc.
Other Complexities
A mismatch of these important information leads to claim denials. This leads to loss in time and effort. Most importantly, it adds to the cost of business. The billing cycle increases and even there is delay in treatment because suppliers hold back supplies until documentation is accurate. Some equipment requires more time. It is not worth the effort and so suppliers eliminate it from their list.
Another impediment towards profitability is billing on time. Late billing leads to delay in reimbursements and affects company cash flow. Sometimes, to cut down on the billing time, billers tend to cut corners. This leads to errors and adds to the complexities. It is because of these complexities that denials are mounting. The pile of denials is forcing companies to overlook the low claim bills resulting in write-offs.
Other types of oversight can also complicate the process. This includes not posting non-electronic denials. In such cases one loses sight of what is due to be recovered from patients. Moreover, not posting means not getting to know how to stop them from happening again.
Ways to Reduce DME Billing Errors
The complexity of DME billing can be checked by following certain best practices. These practices have evolved through experience and have stood the test of time. Some of these practices include:
Quality Control on DME Services
This is the most important pre-requisite for having control over DME billing errors. A dedicated quality control team can help you achieve this to perfection. The scope of the team would include:
- Ensure the supplies provided including equipment is in keeping with the documented policy and beneficiary or representative signature
- Ensure that the environmental modification of supplies or external physical adaptions to the home is done with appropriate signature.
Check Beneficiary Records
This is an equally important pre-requisite which helps you get payments cleared in first round. The scope of this step includes:
- Cross-check the document to ensure that the correct DME supply is delivered and in the right number.
- Check if the patient has other insurance coverage and determine if it is a major payer
- Check that the beneficiary representative signature is present in each document.
- Cross-check the bill to ensure all the supplied units have been billed and the right charges included.
- Check to ensure the coding is correct, the name and address is correct, the service dates is accurate and SSN is correct.
Outsourcing DME Billing Services – The Proven Way of Streamlining DME Billing
The one thing that robust DME billing requires is an expert team of DME billers and coders. They must be thoroughly acquainted with every guideline pertaining to DME billing. Third-party DME billing service providers have a team of expert resources who understand the billing process inside out. Besides, they have multi-tier quality checking process to ensure there are slips ups in the process. It is because of this well-established process and easy availability of experts that it is possible to bypass the complexities of DME billing.
Who We Are and What Makes Us an Expert?
This blog is brought to you by MedBilling Experts a specialized back-office service provider for medical billing services. We have over a decade of experience in providing DME billing services to a number of practices in the US. Over the years we have developed a robust process to make DME billing services error-free. The process is driven by thorough and updated knowledge of current-day regulations and proper quality check methods. Get in touch with our experts to know more about our services.
