How HME is Different from DME Billing

It is always seen that many people often get confused when DME and HME billing is concerned. In the healthcare industry, there is a very thin that separates the HME from DME billing.

Being concluded as one dimensional the DME equipment are walkers, wheelchair, etc. In fact, Health insurance carriers, Medicare included, covered these items as a “DME” benefit when a doctor indicated that there was medical urgency requiring the use of any of these items. However, this one-dimensional view of DME never took into consideration that the item that is categorized as DME can also be providing HME services too. However, HME is the item providing medical equipment services to patients in their homes and has never been one-dimensional but multi-dimensional which can also withstand repeated use.

However, even there is the slightest difference in the HME and DME domain but as far as HME and DME billing is concern, everything is the same.

Starting from the process of data entry to meet the eligibility, prior authorization, or the credentialing requirements as set by respective insurance companies both have to undergo the same process during the billing section. In fact, a normal HME and DME billing process involves:

• New Patient Order Entry

• Eligibility

• Prior Authorization

• Doctors Office Follow up

• Confirmation

• Submission of Claims

• Rejection Management

• Payment Posting

• Denial Management

• Customer Service

FAQ's Section

What is the common mistake in HME and DME billing?

• Simple billing and coding errors

• Incorrect entry of patient information like the patient’s sex, name, DOB, insurance ID number, etc

• Late submission of the DME and HME claims

• Incorrect provider’s information like their address, name, contact information, wrong policy number, etc

• Entering of incorrect ICD, CPT or even HPCS codes, conflicting or confusing modifiers to HCPCS or CPT codes

• Duplicate of DME and HME billing; which is when a patient has received two identical treatments or procedures that would effectively double the amount sent to the payer; which is a huge problem.

How can you avoid these HME and DME errors?

• Trying avoiding common billing and coding mistakes – research has seen that incorrect data, missing demographic information, spelling mistakes, etc all these billing errors add up to is $17 billion. However, all of this can be avoided if care measures are taken.

• Ensure continuous follow-up on your Claims –failing to track and following up on DME and HME claims lead to unpaid claims directly influences your funds and profits. This is why continuous follow-up on claims helps you know whether your DME claims weren’t transmitted properly or there is a problem with it. In fact, a continuous follow-up can help it resolve quickly.

• Ensure timely submission – delays in the DME claims often prove to be costly for providers and most payers have a time limit, timely submission of claims not only reduces the chances of denial but also helps in faster reimbursement rate.

• Outsource a team of expert billers and coders- it is seen that, in-house billers and coders due to a huge volume of administrative task and billing responsibilities are often seen juggling in between the tasks, which resulting in divided attention in the DME and HME billing process along with errors and delayed billing processes. Whereas in the case of outsourcing you no longer have to worry about your billing issues and can focus on patient care.