DME billing is important for suppliers to maintain compliance and maximize the revenue process. One of the essential components of the billing process is the Standard Written Order (SWO). The SWO is an important document which serves as the prescription for the DME items and is needed by insurance payers and Medicaid. It also outlines the specific quantity, equipment, and duration of each prescribed item. The SWO acts as evidence in which the DME suppliers received a valid order from the healthcare providers. Now, let’s dive into the other rules which are significantly affecting the DMEPOS world.
CMS Proposed Rules for DME
There are several DME billing rules which are affecting the current market landscape. These start from DMEPOS competitive Bidding Program Amendments to Supplier Enrollment Requirements & Surety Bond Rules for DMEPOS suppliers.
DMEPOS Competitive Bidding Program Amendments
This rule revises the working principle of the DMEPOS Competitive Bidding Program. For example, it can help you to fewer contract suppliers using the 75th bid percentile for the calculation of Single Payment Amount. Its main purpose is to control the spending of Medicare Part B, drive values in supplier contract, and ensure fewer over-payments for the DME suppliers. Always remember that it creates a big impact on reimbursement and supplier margins.
Prior Authorization & Pre-Claim Review Initiatives for DMEPOS items
CMS has programs where the DMEPOS items should have prior authorization or pre-claim review before payment. For example, CMS has published a “Required Prior Authorization List” which has the purpose to curb improper payment and fraud. It can also protect the Medicare Trust Fund while ensuring that the beneficiaries get the equipment needed. So, for the providers, it means the billing process needs to handle PA requirements or claim denials.
DMEPOS Supplier Accreditation and Quality Standards
The DMEPOS suppliers need to meet CMS-approved accreditation, and it adheres to the quality standards. A recent document titled “Final DMEPOS Quality Standards” has become effective from August 12, 2024. The purpose is to ensure that the suppliers are legitimate, safe, and also high-quality. This rule also reduces the risk of poor performance and protects patients. So, these are the proposed enhancements which are noted in the recent commentaries.
How DME Billing Services Tackle This
The outsourced billing experts work with different specialties, starting from staying updated with the latest regulations to using the right technologies. Healthcare regulations are continuously changing because new diseases are coming each day. As the healthcare staff has to take care of all the healthcare administrative hassles, that’s why they don’t have the time to invest in patient care. Here, you need the help of a DME billing company who stays updated with all the complex nuances of the latest codes to make sure no claim denial occurs. They also know how to utilize HIPAA law to protect patient data. It has been observed that prior authorization is complex, and it also takes a lot of time. Here, the billing services come whose experts stay updated with all the small changes of the prior authorization process. These experts do not need any binding contracts having no clauses. In addition to that, these experts provide customized reporting according to the client’s needs and infrastructure setup to make sure no issue occurs. They also help with other specialties such as DME, gastroenterology, orthotics and prosthetics, cardiology, urgent care, and many more specialties. So, if you want to streamline your billing process, it can be a feasible option to outsource DME billing experts in that matter.
The Future of DME Billing
The future of DME billing looks very promising. Technology plays an important role in quickening the claim submission process. The manual process consists of a lot of errors. It also takes a lot of time to perform. Now, if the healthcare staff focuses on these issues, it will take their attention away from patient care. So, you can outsource DME billing experts who know how to use the clinic’s EHR process to store patient data. These companies can reduce your operational costs by 80% and work with a 10% buffer resource to make sure no issue occurs. They also know the usage of electronic prior authorization procedures to submit claims electronically. So, with their help, you can improve your billing process, which can increase patient satisfaction to a large extent. They are 100% HIPAA-HITECH compliant and provide rapid claim status analysis in denial management. These experts have free account supervisors and IT infrastructure setup. There are several denial reasons such as authorization issues, coordination of benefits, inclusive procedures, EDI rejections, PIP cases and many more. these companies work with 99.9% accuracy full range of verification services. All their coders are ICD-10 certified and has undergone extensive medical coding training to avoid denials.
