Durable Medical Equipment providers are always striving to handle DME billing complexities and acquire adequate revenue. Dealing with the delays in receiving reimbursement can be burdensome and stressful. There is a need for a systematic approach that can improve revenue cycle management and operational flow.
One factor that has a great influence in dictating the clean claim rate is Medicare. If healthcare providers learn to manage through Medicare, then they can simplify and elevate their medical billing process.
If you are a DME provider, understanding the terms of Medicare is an essential part of optimizing medical billing. However, as a healthcare provider, you may not have enough knowledge about it. That is why this blog is for you.
In this blog, you will understand how Medicare dictates the medical billing and coding landscape. We will also learn how outsourcing medical billing services can help you handle various complexities.
Durable Medical Equipment Coverage in Medicare
Durable Medical Equipment (DME) does come under part B of Medicare coverage. Under this, the equipment that helps patients in carrying out their day-to-day activities is covered.
To be specific, the coverage involves points such as:
- The equipment (durable) is meant for continuous use for a period
- The equipment must be for medical purposes and not for leisure
- The equipment must be fit to use at home
- The equipment must sustain for three or more years
This is just the basic idea of Medicare coverage but there are various rules for DME for both healthcare providers and patients.
As a healthcare provider, you must be aware of which equipment is covered and which is not.
Let's simplify it for you:
Covered DME
So, the type for your insurance plan can be anything but the DME coverage is almost the same for the plans. It includes DME such as:
- Wheelchairs
- Walkers
- Hospital Beds
- Power Scooters
- Portable Oxygen Equipment
There are some other inclusions in part B of Medicare that include prosthetic devices meant to replace organs such as:
- Prosthetics – Artificial Legs, Arms, and Eyes
- Orthotics – Completely or Partly Rigid Leg, Arm, Back, and Neck Braces
This was just the equipment, but some medications are also a part of this. These are medications used with the necessary DME based on the ailment. Some other things are also included such as nebulizers, test strips for self-testing, and lancets.
All these are a part of medical billing and coding, and they also make the billing intricate. To streamline the revenue cycle, healthcare providers need to be familiar with all the equipment and its impact on the medical billing process.
Another way to never make any mistake regarding DME billing is partnering with medical billing services. Such services are already proficient in managing the administrative process of DME providers. They are well aware of the equipment and with this, they easily navigate through the complex process.
Not Covered DME
Just like the covered equipment, healthcare providers must also know about what’s not covered under Medicare. This helps in clearing any confusion while insurance eligibility verification is the process of medical billing and coding.
The equipment not covered includes supplies meant to be used outside the home. Other than that, supplies made for only one-time, or items that must be thrown after some uses are not covered.
One major factor that distinguishes covered and not-covered equipment is that DME is not made for convenience and comfort. It must also not be a part of home modifications.
Some examples for not covered Durable Medical Equipment are:
- Surgical Facemasks
- Incontinence Pads
- Bathtub and Toilet Seats
- Wheelchair Ramps
- Wheelchairs or Scooters Made for Use Outside the Home
Only a few modifications are allowed under the Medicare Advantage Plans.
Healthcare providers must know the difference between allowed modifications and unallowed modifications.
Complexities in DME Medical Billing
Durable Medical Equipment comes with various medical billing complexities. Understanding the requirements of Medicare and then putting that into effect while dealing with patients is crucial for adequate revenue.
The major complexity that comes is in coding. Every patient is unique, and this makes their DME requirement also different. Not being able to allocate accurate codes at the time of claim filing leads to denials and revenue leakage.
Some other complexities are:
- Manual Errors While Recording and Documenting Patient Data
- Improper Insurance Eligibility Verification
- Non-Compliance with HIPAA Regulations
- Faulty Denial Management and AR Follow-Up
- No Focus on Claim Processing
Outsourcing Medical Billing Services for DME
Medical billing services work with many healthcare providers and practices. This makes them familiar with frequent errors and most prominent complexities. They know the right way to handle administrative tasks and maximize revenue.
Similarly, in the case of Durable Medical Equipment, professionals understand Medicare and perform medical billing based on that.
A medical billing company can handle all the steps in less time than any other healthcare provider or in-house staff. It not only saves time but also prevents resources spent on maintaining an in-house billing staff.
As a result, DME providers can shift their focus from medical billing to providing quality patient care.
Bottom Line
The best option to deal with complex medical billing for Durable Medical Equipment is partnering with a medical billing company.
If you are a DME provider looking for premium medical billing services, then Eminence RCM is the right choice for you.
Eminence RCM is a well-known medical billing company in USA providing billing services to DME providers. We have firsthand experience in handling the intricacies of medical billing for Durable Medical Equipment.
Our team of certified professionals is competent in identifying Medicare terms to help you attain adequate revenue. Your patient data is safe with us as we are HIPAA compliant. Our credibility lies in delivering quality services free from errors and denials. We maintain a database of CPT and ICD codes relevant to Durable Medical Equipment to always ensure coding accuracy.
At Eminence, we use advanced technological solutions to eliminate manual errors and missing information. With our medical billing services, you can improve your revenue cycle management, and boost your bottom line.
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