Know Your DME Billing Process Well

DME Billing is a bit different if seen along with the other genres of medical billing. A Durable Medical Equipment (DME) provides therapeutic benefits to patients suffering from certain medical conditions and/or illnesses. A DME is built to serve a medical purpose with the ability to withstand regular use, appropriate for using it in the home. Regular DME items include:

Compression sleeves

However, it is surprising that despite the importance, DME billing has a lot of uncertainty surrounding it. It is really unfortunate that despite DME providers getting sufficient physician orders for supplies, quite often they struggle to recover the expected revenue.

Different DME companies have different DME billing styles depending on the frequency. Some companies bill regularly as and when required while several others bill a few numbers of times through the year. DME billing needs to be extremely meticulous and accurate as a single mistake in the billing of just one medical device can bring a loss of thousands of dollars for a DME seller.

To work on the loopholes of DME billing of provider/seller, we need to understand the DME billing process.

DME Billing Process: A Brief Overview

Here are the key components of a typical DME billing process:


The primary requirement for DME billing is a prescription from the ordering physician for rent/ purchase mentioning with the quantity of the DME mentioned.


Verification of the demographics and other patient data before filing for claims.


When DME-suppliers bill they need to meet the credentialing criteria before applying for reimbursement. Note: The billing for DME providers is sent to the DME carrier and not to Medicare Part B carrier. However, an exception is the covered cast supplies.


The CMS-1500 is the designated form for process a bill electronically.


Completion of documentation with physician’s treatment plan needs to be ensured, along with the time frame for the DME usage.

Codes and Modifiers:

It’s very important to apply the appropriate HCPCS codes, procedure codes, maintenance, and repair modifier codes. In the absence of an apt code, the E1399 or other HCPCS codes can be used. Note: A denial can result in case HCPCS is used before the expiry of a product lifetime (1-3 years generally).

Factory Invoice:

A physical invoice (not electronically sent) must be attached containing the complete description of the item along with the medical necessity form signed by the physician. Note: All the initial documents must be enclosed in one envelope and then get submitted. The electronic processing cannot be commenced before this.


The Date of Injury (DOI) must be mentioned clearly. If required, mention the Date of Service (DOS), which is the day the patient died or the day the patient stopped using the DME. Note: The date of service is the date the patient receives the equipment. It is not the date of shipping to be precise. The only exception is a patient’s cancellation of the order where the date of service becomes the date the equipment order is canceled.

Supporting Documents:

Attach the documents to support the necessity of the product, like chart notes, surgery notes, LMN/CMN, product description, etc.


The coverage starts on the day the apparatus is delivered, setup/installed, and ready for the patient’s use of the place desired (usually home) or at a skilled nursing facility.

Repairs claim:

Bill any claims for repair with an entire explanation of the services.


11 Solid Reasons Why You Need to Outsource Your Medical Bills

1. Claims are not filed on time

Professional outsource medical billing experts understand the system and have a knack for filing claims accurately and as promptly as possible. This ensures that you get to receive your payments on schedule and do not have to wait for months to receive what’s yours.

2. Coding problems cause rejections

Coding problems are one of the chief causes of claim rejections and consequently, loss of claims. Outsource medical billing services have first-hand knowledge of codes and filing procedures to ensure that all medical claims are not only filed on time, but filed properly.

3. Outsourcing helps to cross common hurdles associated with claims

A plethora of challenges often arise when considering medical billing and claims filing. Common issues that can cause claims to remain unpaid or forfeited include:

4. Patient information inaccurate or not updated.

5. Claims are filed and processed to the wrong place.

6. Patients either can’t afford to pay or won’t pay, thereby leaving the business to inherit their liabilities.

7. Patients may be liable to pay for services uncovered by their insurance. This leaves you, the physician performing many financial logistics, issuing invoices and following-up.

8. Collection agencies can confer a bad image and PR on your business

While some organizations and medical establishments may opt to use collection agencies to recover their monies from patients, it is imperative to note that these agencies can be bad for patient relations, company image and can cost as high as 50 percent upwards of the monies collected. Outsourcing medical bills and claims can help to effectively manage cases like these and ensure that your business is not on the losing side.

9. Curtail unnecessary financial implications on the part of your business

According to gathered resources, properly prepared claims can take anywhere between 30 and 120 days to receive attention by insurance companies, Medicare or Medicaid. At times, physicians are left with no choice but to borrow money to cover the immediate expenses of the business while awaiting payments that may arrive in weeks, months or never even come back.

10. Slump rejection of claims

As mentioned above, the rejected claims rate stands at 30 percent. Outsourced medical services have shown tremendous turnaround with claims and have demonstrate the ability to reduce rejected claims to an enviable 2 percent

11. Reduce financial losses

With professionally handled medical bills, claims and payments, your business can make sure that it receives patient’s monthly payments as at when due for their outstanding balances and liabilities owed to your business as at the time the services were provided.

You can also collect on old accounts receivable rather than total forfeiture without expending legal costs or using a collection agency.

If you’ve been practicing and billing third partied for patient visits, consultations, treatments and any other medical services or products, chances are, you’re already familiar with these hurdles. Sometimes, physicians do not recognize the huge cash crunch that the cost of medical billing, forfeitures and refusal of claims accumulate to on their business. Outsourcing on the other hand avails doctors of a way to utilize professional billing services and medical claims for their business to counter discrepancies that can delay, reduce or prevent payments altogether.

As at today, rejections are capped at around 30 percent in the industry. Due to the voluminosity of claims filed and handled, even the smallest errors can trigger rejections, and as such, it is imperative to use outsourced services to ensure perfection in handling medical billing and claims. According to Keith Borglum, owner of Management and Marketing, Santa Rosa, CA, a single medical practice recorded an error rate of 71 percent in a year which saw the business accrue $185k in losses.

Outsourcing presents a plethora of opportunities to handle leakages in your practice stemming from both medical claims, filing errors, evasive patients or those who simply have no clear cut means of paying you money to ensure that you stay afloat in your medical practice and do away with unnecessary costs that can leave you running at a loss.


Medical Audits – Why You Need One Right Away

Audits are important tools that ensure the proper management of finances with a strict adherence to established rules and regulations why exploring areas where internal process improvements can be implemented.

For physicians and healthcare providers, the importance of audits, particularly for medical claims cannot be overestimated. Generally, there are two major areas where claims audits present better medical operations practices. First, the audits of operations within your practice also termed as self-audit, is used to determine grey areas, areas where mistakes are being made and areas where improvements can be made to drive significant difference. The other is the audit of the claims administrator.

In the absence of proper management, medical claims can be very costly and complicated. It can even go as far as damaging business reputation. Irrespective of the area being explored by the audit, an audit process generally:

• Locates errors made in medical billing

• Proffers solutions for improving recovery opportunities and

• Ensures that a medical establishment and practice is in tune with the latest compliance guides and regulation that govern medical claims

There are also many other benefits of medical audit claims.

The medical administrator audit claims highlighted above is an independent audit that aims to identify discrepancies in both lost monetary opportunities and adherence to regulations. It is an audit that show how your claims are being handled by the claims administrator and a string reiteration of your commitment to being frugal with every penny being spent as well as ensuring that it is being spent as it should.

This audit is very important as the centers for Medicare and Medicaid services has reported that as many as 12.7 percent of Medicare fee-for-service claims have errors. No matter the size of your medical practice and number of employees, audits serve a great purpose.

To remain thorough, audits should also not be done once but slated for a routine check in order to improve the medical claims process over a longer span of time.

Such audits can be a Random Sample Audit, Hybrid or Comprehensive audit. The extended benefits of a self-audit also include:

• Preventing and lowering the chances of improper payments

• Ensuring the accurate submission of claims

• Improving patient care

• Lowering the need for an external audit

• Reiterating the need for corrupt-free practices within the staff and organization as a whole

Self-audits require thorough examinations of the claims process within your organization and your employed medical practices, it also helps you to make the best evaluation of areas of “risk” that are most susceptible to errors.


Medical Billing Services – Choose Wisely

It’s not news nowadays that healthcare providers are heavily outsourcing their medical billing services to professional companies to look after their medical billing and collections. A number of physicians, hospitals, nursing homes, urgent care centres, laboratories, DME companies, and other entities associated with the healthcare industry have realized the need for professional handling to regain focus on revenue recovery mainly through the reduction in operational costs.

There lies another challenge ahead – to find out the proper medical billing service, which can provide you with the solution you are looking at your budget. It is extremely important to research rigorously by self-defined parameters for selecting the desired service. However, some common factors that can be broadly considered essential for most healthcare providers can be discussed:

Points to Ponder

Some basic points that cannot be overlooked in your search for the desired medical billing assistance will include the following:

• Accurate and efficient service: Go for the medical billing services that can take the onus of all your billing collections – accurate, complete, and timely payment from the third party payers and patients through latest technology to attain maximum efficiency in the system.

• Excellent references: Revenue is the key focus and you need more business for that and for more business you need more references. Look for medical billing services that have enough experience and reputation to provide you excellent referrals from physicians.

• Expert coding: Coding is one of the most important aspects of medical billing in this time of EMR and EHR technology. Sought medical billing services that can provide you with the required expertise in ICD-10 coding. Due to an absence of certified and experienced coders in their in-house team, most of the practices suffer from common coding issues like:

o Unbundling: Unbundling involves listing of different billing codes for charging for services falling under one billing code. This results in bill getting inflated because the items that should have been billed as a package rate get billed separately.

o Balance billing: This coding error arises when the balance bill sent to the patient after the insurance company’s price negotiation with the care provider and all of the hospital’s charges are supposed to be covered under the patient’s policy.

o Duplicate Billing: Another common billing error, which involves multiple bills getting generated for the same procedures or services.

• Dedicated account management: Always prefer a service that provides you, experts, to dedicatedly look after your collections without any extra charge. The account managers should always be within your communication range to provide assistance during an emergency.

• Flexible services: Sometimes you might need a single service like prior authorization. Choose a medical billing service that can offer you standalone services as and when required and not charge for a whole package for RCM or other packages. It should also be flexible enough to work in both the electronic and manual platforms as per the requirement.

• Special edge: A great and a good medical billing service can be distinguished by the virtue of that ‘something special’ it offers. A great medical billing service can maintain a seamless healthcare management through cutting-edge services for the patients, providing your practice with the professional guidance it needs to complete a comprehensive end-to-end revenue cycle management. An experienced and reliable company can do the trick for you by achieving the seamless overall transitions from your time and cash stripped condition to making your practice revenue-healthy, up, and running.

Errors, both electronic and human can nag your practice from getting the desired result. Signing a really able medical billing service will provide you with the shield from those errors saving you unnecessary loss of time and money!


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