Difference between HME & DME Billing Services

If you are not completely familiar with medical billing services, you may think why codes for both the durable medical equipment (DME) and home medical equipment (HME) are present.

Are they different?

As the two terms suggest, the purpose of them to the rigorous requirements along with them, you need to understand how insurance views these billing codes and why they mean important for your claims.

Durable medical equipment is the item needed to support a medical need. DMEs include ambulatory aids, oxygen tanks, special hospital beds, wheelchairs, special commodes, compressors, and more. Most health insurance companies along with Medicare define these as DME benefits, particularly when a doctor suggests an absolute medical necessity for using any of these items.

One of the important aspects of DME billing is that even if the item is mentioned as DME, prescribing such items comes under HME billing, as they belong to a home medical equipment service they are being used as. This is mainly due to the provision of home-based medical equipment services is never thought about as a one-dimensional thing. Although, these services are multidimensional as the patients needing such DME services have to deliver these items to their homes.

DME Billing: In DME or durable medical equipment billing, a home assessment is necessary to make sure that the appropriate safety requirements are followed in the particular home for any suggested item before it can be delivered or installed, according to the case. Some of the home equipment billing companies consider if the equipment has been set up by the people trained to do so.

DME billing companies also insist on the recipients following all the instructions that explain the usage and operation and maintenance. If they encounter any operational failure, they have to seek help to set things right. Appropriate instructions also need to be set up for users/attendants on how to monitor and report changes in the medical conditions of the patients, and expert aid in verifying if the particular DME is covered by insurance.

Practices also need to check for durable medical equipment billing companies if there is around-the-clock help available in case of any emergency popping up, particularly when there are holidays or after office hours. The DME billing services agencies also need to be prepared to assist the patients when challenges with reimbursement occur due to the insurance carriers and promote these issues on their behalf to resolve issues. In case the purchase is not complete, the DME items need to be retrieved from the patients’ homes, which also is a considerable part of DME services.

HME Billing: When you want to deeply understand home medical equipment (HME), the providers need to make sure to hire and train the expert staff with insurance coverage provided by carriers for all DME items. DME billing services include are in communication with medical professionals and they need to stay in touch with the ailing patients along with the paramedical health experts. The HME billing companies have to make sure that accurate instructions for operations and maintenance of DME items are given.

A part of home medical equipment services providers is checking if appropriate sanitation and reconditioning of returned DME items were in place and if safe transportation practices (vehicles) and maintenance processes were practiced. The HME billing companies need to take care of the 24/7 service was provided to the patients at their homes. FDA licensure for HME is an important part that needs to be met. HME service providers on their side may be handling practices in various locations. They have to focus on inventory, staff, along with taking care of logistics and establish communication procedures in place.

While about just 20 to 25 years back, HME services were handled by delivery technicians and respiratory therapists in a few circumstances, the services today have reached another level of sophistication, due to technological advancements.

Today, highly trained clinicians with multidisciplinary backgrounds such as pharmacists, nurses, diabetic counselors, physical therapists, dieticians, respiratory therapists, and more are working with HME service providers. Because of this, HME billing services have become a specialized domain; hence most providers prefer to outsource home medical equipment billing to vendors with skilled and experienced staff to take care of the billing.

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