DME Medical Billing Services Maximize Payment, Minimize Denials
DME billing is a big part of medical billing and coding. HCPCS Level II codes capture non-physician services, supplies and durable medical equipment. MedCod MSO is a certified DME billing company that knows the unique coding requirements of DME. Partner with us get paid more patient satisfaction and focus on what matters most patient care.
Outsourcing Medical Billing for an Efficient DME Billing Process
1. Complex Coding:
CMS updates HCPCS Level II codes for DME in medical billing every year medical billers need to update codes These complexities can impact claims big time and requires attention to detail.
- HCPCS Level II Codes: DME claims rely heavily on Healthcare Common Procedure Coding System (HCPCS) Level II codes. These codes are alphanumeric and are used to identify products, supplies and services not covered by CPT codes.
- Specific codes for specific items: Each piece of DME has a specific HCPCS code to categorize its use, type and medical necessity. For example, a semi-electric hospital bed with head and foot adjustment uses code E0260 while a CPAP machine is coded E0601.
- Different codes for renting or purchasing: DME medical billing allows for both renting and owning equipment and specific codes are designated to distinguish between the two.
2. Documentation complexities
Accurate documentation is the foundation of DME billing compliance. This includes:
Detailed physician orders: also known as a Standard Written Order (SWO) or Detailed Written Order (DWO), is a document that confirms what a physician has prescribed for a patient. Must be signed, dated, specify the exact DME, patient’s diagnosis, patient information, physician information, length of need and any special instruction. For DME drugs under the DME benefit the order must also specify: drug name, dosage/concentration, duration, quantity and refills. The detailed physician order acts as a bridge between the physician’s prescription and the DME supplier’s billing process, so the right equipment gets to the right patient and the claim is properly supported for reimbursement
3. Prior Authorization
Streamlined prior authorization (PA) in Durable Medical Equipment (DME) billing refers to optimizing the process of obtaining approvals from insurance payers before providing DME items to patients.
- Time consuming
- Complex
- Frequent updates
- Manual processes
- High denial rates
4. Denial Rates
- Frequency: 20-30% of DME claims are denied initially, that’s how prevalent errors in documentation and coding are. One industry report says up to 20% of all medical claims are denied on the first submission.
- Impact: Denied claims requires costly and time-consuming rework, average cost of rework is $118 per claim for complex DME cases.
- Causes: Common reasons for DME claim denials are inaccurate coding, insufficient documentation (missing patient info or prescription), no prior authorization, insurance coverage issues.
Also using outdated coding resources and not meeting specific payer requirements contributes to denials.
5. Delayed Reimbursements
- Causes: Failure to get proper prior authorization is a big factor. Long processing time for claims that requires manual intervention also contributes to delays.
- Impact: Denied claims requires costly and time-consuming rework, average cost of rework is $118 per claim for complex DME cases.
- Consequences: Besides financial strain, delayed reimbursements can also impact patient care by delaying access to equipment. This can lead to patient frustration and potentially harm the provider’s reputation.
Regulatory Compliance Risks
- Incorrect HCPCS codes
- Upcoding and down-coding
- Unbundling codes
- Duplicate billing
- Missing or incorrect modifiers
- Outdated codes
- Consequences of failed audits
- Inadequate medical necessity documentation
- Missing or incomplete patient records
- Failure to maintain proper proof of delivery
- Varying payer guidelines
- Prior authorization requirements
- Anti-Kickback Statute (AKS) and Stark Law violations
- False Claims Act violations
- Providing faulty or non-compliant equipment
- mproper handling of PHI
- Insufficient data security
- Inadequate business associate agreements
- Increased scrutiny from government and private payers
How MedCod MSO Simplify Your DME Billing
Accurate Coding
- Certified Coders
- Code Selection Modifier
- Diagnosis Code
- Stay Current
- Review
- Timely & Consistent Documentation
- Payer-Specific
- Eligibility
- Prior Authorization
- Timely Filing
- Internal Audits
- Staff Training
Benefits of EPA
- Faster approvals
- Better patient care
- Diagnosis Code
- Less administrative burden
- Less errors and rework
- Better communication and transparency
- Payer-Specific
- Eligibility
- Prior Authorization
- Timely Filing
- Internal Audits
- Staff Training