The ABCs of DME Billing: A Checklist for Getting Paid

DME claims are no longer paid with little to no further evidence required. In recent years, Medicare and other private insurance companies have increasingly demanded thorough paperwork for each submitted claim. Obtaining and filing extra documentation is critical for DME providers as many of these documents will be required to be shown during an audit. In fact, it is advantageous to have systems in place that make use of DME Billing documentation checklist. These procedures ensure that you collect the necessary documentation for each order. Simultaneously, an effective filing system can help ensure that your claims are paid on time and are audit ready.

Therefore, medical billing is a complicated process that most DME providers must manage in addition to providing medical equipment. If the provider is to be compensated, the following specific specified standards must be completed:

• Accurate patient registration

Patient registration does not have to be a face-to-face engagement for DME providers. Dealing with documentation and confirming that the information provided is accurate and comprehensive may be part of the patient registration process. This could harm the claim application process if it is not guaranteed at the start of the DME medical billing cycle. Reimbursement may be delayed due to incorrect or missing information.

• Processing patient and physician DME Orders

DME Medical billing heavily relies on collecting medical equipment orders from patients and clinicians. The higher the number of orders, the larger your DME setup.  This can be difficult as some equipment may only be reimbursed if detailed documentation is provided, such as prescriptions, medical necessity, doctor's or nurse's medical notes explicitly stating the need for the equipment and prior authorization.

• Medical documentation

Medical document review is a process that applies to DME claim applications. Documentation for expedited clearance could include the following:

• A doctor's prescription for specific medical equipment.
• Treatment plan in depth.
• A few notes or details on a predicted outcome. This can be in the form of a doctor's note.
• Notes or prescriptions that can be used to determine medical necessity.
• Due diligence on patient registration

Patient registration entails capturing patient information. These facts include the patient's demographics as well as their medical history. In other circumstances, patients may need to be aware of the actual premium, co-payments, equipment coverage, etc.

Furthermore, DMEs must ensure that patient registration adheres to HIPAA laws, as medical histories and records frequently contain sensitive Personally Identifiable Information (PII). Hackers can access PII for wrongful use in a scenario where data is mainly transferred online. Thereby, HIPAA-compliant DME medical billing processes can significantly reduce this risk.

• Recording and managing DME orders

Order-taking can quickly become chaotic in a high-volume setup, such as a mid-sized DME ready for next-level expansion. Multitasking employees who are pushed for time may be tempted to use paper notes. When these paper notes are not properly stored and organized, they can result in missing records.

• Claim application procedure

A successful claim application procedure depends on the type of equipment requested, the patient's history and medical needs, the doctor’s paperwork, and the DME's successful patient information and data management. Missing or incomplete links might cause claim processing delays. In the event of data mistakes, claims may be rejected, resulting in a loss of reimbursement for the DME.

Outsourcing DME Billing – One-Stop Solution!

Do you need help to keep up with the ever-changing DME billing landscape as a result of new laws implemented by policymakers? Are you concerned about declining collections, the cost of training new recruits for billing responsibilities, rising billing errors, and operations being halted while your staff goes on leave? Then it would be best if you considered outsourcing DME billing services.

If the current DME billing issues are not addressed, they will exacerbate, resulting in more downtime and revenue cycle management loss. If you are frequently bogged down by these obstacles, outsourcing your needs to our DME billing company, such as 24/7 Medical Billing Services, is your best bet for overcoming difficulty. Our team never takes a day off and works nonstop to provide you with the highest reimbursements.

See also: 5 Most Common Mistakes To Avoid When Outsourcing DME Billing Services