DME BILLING SERVICE
DME suppliers often face the same billing challenges repeatedly. Examples include denied claims, delayed payment, and staff re-working billing records due to additional documentation requested from a payer, or an invoice that does not match the equipment that was shipped to the patient. These billing issues impact the timely availability of cash flow in the DMEPOS business, which can also make it difficult for the business to obtain reimbursement from Medicare, Medicaid, or commercial insurance plans.
DME Billing Service supports a DME supplier’s billing side by managing the full billing cycle for durable medical equipment. This includes verifying coverage and eligibility with the patients' insurance carrier, collecting and assembling all necessary documentation, using the correct coding and modifiers, submitting claims to payers, tracking claims, posting payments, and managing denial, correction, and appeal processes as necessary.
As a result of using a DME Billing Service, the operational or business aspects of a DME/HME company (such as ordering, delivering, processing paperwork, and conducting follow-up on the patient) are not impacted by billing-related issues. Consequently, DME Businesses stay profitable and vendors receive timely and complete reimbursement for orthotics, prosthetics, and wheelchairs.
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What’s Included In This DME Billing Service?
Collecting Patient and Insurance Data
At the beginning, all relevant data about the patient and his/her insurance will be collected. Then, a check is performed regarding the eligibility of the patient for benefits under his/her plan, to verify that the DME/HME benefit is covered by this plan, and to see if prior approval is needed from the payer.
Organizing Required Documentation
All necessary paperwork is organized, and documented as it relates to the specific item being delivered to the patient. In most cases, this will include the original prescription order, medical records (chart notes), a document verifying delivery of the item, and any forms required by the payer for processing of the DME and HME claims.
Preparing and Submitting Claims
The DME Billing Service Provider prepares each claim in the proper format, including the use of the correct HCPCS/CPT codes, to ensure that the claim accurately represents the item furnished to the patient. Once prepared, the claim gets electronically transmitted to the applicable payer via either direct transmission to the payer's portal, or through a clearinghouse to the payer.
Resolving Rejections and Denials
If a claim comes back unpaid, the reason is reviewed first to determine why it was denied, and/or what additional information is required to resubmit the claim for payment consideration. Then the missing detail is added or the error is corrected, and the claim is resubmitted.
Posting Payments and Patient Balances
When payments are received from the payers, those payments will be entered into the billing system to record the amount of the payment made by the payer, and what balance remains due from the patient. Any differences, like deductibles, co-pays, co-insurance, and reductions applied by the payer, will also be entered into the system, to avoid confusion when calculating patient balances.
Monitoring Unpaid Claims and Providing Updates
Claims which remain unpaid/closed-out, or have no status update from the payor, will continue to be monitored until resolved. During the process, the DME Billing Company will provide periodic updates to the supplier, regarding the status of the claims; specifically, what was billed, what was paid, what was denied, and what is currently pending.
What’s Included In This DME Billing Service?
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