Durable Medical Equipment (DME) billing presents significant challenges to suppliers. From oxygen machines to hospital beds, timely reimbursement is essential to boost the financial health of DME suppliers. On top of that, Medicare’s complex rules often cause further delays. The below actionable steps to streamline DME billing will help suppliers secure payments faster, reduce stress, and boost revenue.
Step 1: Confirm Patient Insurance Coverage
DME billing experts should begin by checking the patient’s insurance details. They need to verify Medicare Part B coverage for DME items like walkers or nebulizers. Moreover, they should ensure the patient meets medical necessity criteria. Using the Medicare Beneficiary Identifier (MBI) will efficiently confirm eligibility.
In addition, calling the insurer to clarify coverage specifics will make them confident to process the claim. This step will help to avoid claim denials from incorrect information. Thorough verification saves time and ensures quicker payments. Billing staff should review policy details carefully before moving forward with the claim.
Step 2: Secure Prior Authorization
Certain DME items need prior authorization from Medicare. Power wheelchairs and oxygen equipment often require approval. DME billing specialists need to submit physician orders and medical records to prove medical necessity. In some specific cases, payers may ask to include a signed certificate of medical necessity by registered physicians.
Furthermore, CMS requires prior authorization for specific DMEs to prevent denials. DME staff should complete this step early to avoid rejections. Proper documentation speeds up the approval process. Missing pre-authorization will instantly lead to claim denials.
Step 3: Apply Correct HCPCS Codes
Accurate coding is essential for DME billing. Coders should accurately apply HCPCS Level II codes for specific DMEs. For instance, a semi-electric hospital bed uses code E0260. Hence, if they mistakenly apply the E0250 code, the claim will end up on the denial list.
Moreover, the AMA updates medical codes every year. Hence, DME billing staff members should follow their guidelines. Wrong codes cause claim rejections. Billing staff should verify codes using the CMS DMEPOS fee schedule. Correct coding aligns claims with Medicare standards, as well as reduces delays, and ensures faster reimbursements.
Step 4: File Claims Electronically
Electronic submissions speed up claim processing. DME billing staff need to use the CMS-1500 form. It is available in the Common Electronic Data Interchange (CEDI) portal. Medicare requires electronic filing for most DME claims. Also, delay in claim submission may cause denials.
DME billing staff must know the timely filing limit (TFL) for the specific claim they are working on. They must file claims soon after DME delivery. Furthermore, DME suppliers should check patient details and HCPCS codes before submission to minimize errors and accelerate payments.
Step 5: Document Proof of Delivery
Medicare demands proof of DME delivery. Suppliers need to provide a signed receipt or the patient's photo with the equipment as proof. They must ensure the delivery date matches the claim. This documentation confirms the patient received the item. Missing proof leads to denials. DME suppliers should maintain organized records to simplify audits and speed up approvals.
Step 6: Track and Fix Denied Claims
DME billing staff should thoroughly monitor claims to catch denials early. Common issues include missing records or wrong codes. In addition, they need to review denial notices to pinpoint errors. After that, they should correct all problems, like adding medical necessity details or updating codes, in the claim.
Finally, they need to resubmit claims promptly to avoid delays. Regular billing audits identify patterns in denials. Moreover, prompt action keeps claims moving and improves cash flow.
Finally, Work with a Trusted RCM Partner
Outsourcing DME billing to a Revenue Cycle Management (RCM) provider saves effort. Experts from these third-party vendors manage coding, submissions, and denials efficiently. They stay current with CMS and AMA rules. A reliable RCM provider seamlessly handles prior authorizations and claims tracking. Their services reduce administrative tasks, letting doctors focus on patients. Partnering with professional DME billing companies streamlines billing and speeds up payments. Eventually, practices enjoy better cash flow and less stress.