A Guide on Durable Medical Equipment Billing

 

Medicines or other medical equipment’s can be readily available from a pharmacist, or any resources. But the pharmaceutical industry does not only rely on medications, right? Often the patient’s health deteriorates to the extent that they have to rely on life-saving resources. But what exactly is a Durable Medical Equipment?

Durable Medical Equipment is the abbreviated form of DME. It is an item that is prescribed to patients who suffer from some severe medical conditions. Some medical conditions may weaken the body to such an extent, and they need a source to support their life. Such resources are termed as DME’s.

This Durable Medical Equipment is not cheap for many patients to buy. There is a considerable sum to be paid for even renting the item for a limited time, forget buying! Thus, for the patient to get some relief from the financial crisis, the insurance companies/payers may step in. The insurance company pays a certain amount of claim, provided all the documentation and protocols set in place.

Durable Medical Equipment Billing Durable Medical Equipment Billing

Durable Medical Equipment Billing is managing the overall activities that are taken place to claim for the equipment you rent. The documentation and every minor detail have to be clearly monitored as any misplaced document, or incorrect information can directly lead you to higher chances of denial for claims.

 

Durable Medical Equipment Industry:

DME Industry is necessary, in all regards. When you look at medical history, so many patients suffer from chronic, life-threatening diseases. For instance, the entire world is right now shaken by the Covid-19 virus. There is an utmost need for the DME’s. When a patient is dying out there, is it necessary to treat them first or to have the documents sorted? 

For such instances, there’s a dedicated group of companies that will work on the complete management of renting or purchasing such equipment and helping the individuals gather the relevant data and papers which can help them to claim for such a tremendous amount. 

Also, it is your responsibility to look after your dear ones in such times and not indulge in some secondary affairs. These companies take up all your worry and liberate you from any possible issues. At the same time, making sure you’re not denied from the financial help you deserve. 

There are a lot of devices and equipment that fall under the Durable Medical Equipment. Few of the common and commonly heard are - Walkers, Crutches, Wheelchair, Hospital Beds, Oxygen related equipment, blood sugar monitoring, braces, mobility devices, ventilators, etc. While these are equipment that may not necessarily be purchased but rented for a specific amount, then, in scenarios like this- the billing and the proper coding is to be made sure. The claims will help the patient pay those massive heap amount.

 

Durable Medical Equipment Coding and Durable Medical Equipment Billing

Healthcare Common Procedure Coding System (HCPCS) is a standard code build for providers in the medical industry for health insurances and Medicare. The DME is a complicated procedure as compared to the other medical billing issues. This type of situations falls under HCPCS Level II codes. 

The Durable Medical Equipmentbilling is a procedure, and hence every step must be taken care of, failing, which can lead to a lesser chance of reimbursement. The code should be formulated perfectly, and the entities must be clearly and precisely defined. The information must be on point, and there is no space for any sort of ambiguity.

Multiple people come into picture while DME coding and billing process takes place. From doctors to the patient’s side, Durable Medical Equipment supplier and the coder to the insurance company. All must meet the ends to ensure that the patient is not incurred in debts or losses, the insurance company extends its support.

 

The entire procedure needs to be done in the proper flow. There is an algorithm that is usually followed for such systems. 

  • Once the doctor finds a requirement of any DME for a patient’s medical condition, the documents must be made which will help for claims submission.
  • Upon a request risen for DME, the patient’s end will reach out to a DME supplier. The coder here needs to provide the proper prescription and also collect the patient’s insurance company. 
  • The insurance company may also expect a check from their end. The use of the equipment and the agreement on paying for the equipment as the claim, all these sorts of business are settled here.
  • Upon finishing the necessary paperwork, the material is handed to the patient.
  • The medical coding is then done, the proper use of codes and the correct information is to be made. 
  • The entire procedure is encrypted in the code and handed to the insurance company. The appropriate authorization and billing are needed to ensure the insurance company is liable to pay the claim amount to the patient

 

There are a lot of services offered, like medical billing companies. They keep a record and check if all the documents are on point, and no incomplete or fake information is handed. The process is much complicated and tedious than expected.

The services obtained from a reliable medical billing company is utmost necessary in such regards. They take care and make sure all the documents are genuine, and all the paperwork is on point.

 

What Are Modifiers in Durable Medical Equipment Billing?

There is so much information related to any particular item. Any single code may not be sufficient to point out all the features and information. Hence, to have some extra information regarding the subject, modifiers are something to rely on.

From encrypting the information to giving the details needed for any particular Durable Medical Equipment, modifiers can be used with the HCPCS code. A modifier is used to provide more information. There are many keywords that are used but below mentioned are some of the widely observed modifiers.

  • RR – Rental
  • NU – New Equipment purchase
  • UE – Old Equipment Purchase

Even digging deeper, there are few other keywords that point out at the Rental period. For instance,

  • KH – First-month rental
  • KI – Second and third-month rental
  • KJ – Fourth to 13th-month rental

 

Outsourcing of Durable Medical Equipment Billing:

It is beneficial in all regards to outsourcing DME billing and coding as it eliminates a lot of headaches and is a plethora of time-saving and cost-saving techniques. Instead of rubbing your heads on the documents and other sources, the doctors and health practitioners can concentrate more on the treatment of the patients.

  • The dedicated team is already skilled enough to deal with this and hence the time to train your staff or hire people to take care of these billing requirements.

  • The revenue can also be increased in terms of infrastructure and staff. With no need to hire more people and train them, this surely can be your brownie point.

  • The DME billing is time-consuming and tedious. It can end up taking a lot of your considerable time. This time can be productively used in taking care of the patients.

  • The billing stuff is trained and upgraded with the latest take in the market. They’ll be smart enough to tackle all the happenings in the market.

  • The reliable third-party sources will also make sure that the proper codes and accurate information is handed and nullifies the possibilities of generating errors. The work is done precisely and in the stipulated time period.
  • There is a lot of popular software available in the market that handles the task of DME billing. While the number may go on increasing, some very popular ones have been gaining a reputed position and are reliable for all sorts of DME Billing procedures.

 

Brightree is one of the most renowned and trusted software solutions for all your queries on Durable Medical Equipment’s Medical Billing. Helping you with all the steps, they have helped a handsome amount of people get their claims. From assisting you in generating revenues, they are one of the leading solutions.

Other widely used options are – Practice Suites, Provider Suite, Bflow Solutions. They are one of the most reliable and widely used software available in the market for billing of the durable medical equipment. They are used by professionals who ensure the complete management of billing these types of equipment and its uses.

 

Most Common ICD 1O codes used with Durable Medical Equipment Billing

There are few frequently used ICD 10 codes which target the problems coming under the Durable Medical Equipment Billing. Some of the commonly used ones are: -

  • E0100-E0159 - Walking Aids and Attachments
  • E0163-E0175 - Commode Chair and Supplies
  • E0181-E0199 - Pressure Mattresses, Pads, and Other Supplies
  • E0250-E0373 - Hospital Beds and Associated Supplies
  • E0424-E0487 - Oxygen Delivery Systems and Related Supplies
  • E0621-E0642 - Patient Lifts and Support Systems
  • E0950-E1036 - Wheelchair Accessories

 

In a nutshell

Durable Medical Equipment is used by healthcare professionals when there is a need for the patient to rely on some external sources to support his health and body. Such items bare a cost even if rented, hence there is a complete procedure to undergo for the perfect documentation and other paperwork.

Durable Medical Equipment Billing is often taken as a different department and several experts make the whole process by themselves. When the need arises for a specific Durable Medical Equipment, the prescription is taken to the Durable Medical Equipment supplier. This is coded in the proper format and presented to the insurance company. Proper authorization check, if needed is done and the insurance company checks from their end. The entire documentation and paperwork are then handed to the insurance company and the claim can be generated.

A Durable Medical Equipment Billing is a tough task and hence the software or companies make sure to not indulge in any false or inappropriate information. Clear and concise data is to be given. These types of services should not be constrained in any timeframes. The services should be made available 24*7 for fellow patients. After all, the need for a medical emergency arises at any odd hour. There is no advance notice or time limit for such cases.

Thus a dedicated team can take over these tasks to ensure that the work is done precisely and with no loss for the doctor in terms of time and money. Outsourcing the Durable Medical Equipment Billing & Coding is a suitable and well-chosen option.

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