Durable Medical Equipment Billing


Durable Medical Equipment Billing is managing the overall activities that take place, to claim for the equipment, that the eligible patient needs to rent or purchase. There is a considerable sum to be paid for even renting the item for a limited time. Thus, for the patient to get some relief from the financial crisis, the insurance companies/payers step in.

The documentation and every minor detail have to be clearly monitored as any misplaced document, or incorrect information or coding can directly lead to higher chances of denial for claims.

EXPERTISE

We have 5+ Years of experience working with DME Suppliers & Products billing with a team size of 6.

Below are some of the supplies / equipment's we dealt with.


E0100 – E0159

Walking Aids and Attachment

E0163 – E0175

Commode Chair and Supplies

E0181 – E0199

Pressure Mattresses, Pads and Other Supplies

E0250 – E0373

Hospital Beds & Associated Supplies

E0424 – E0487

Oxygen Delivery Systems and Related Supplies

E0621 – E0642

Patient Lifts and Support Systems

E0950 – E1036

Wheelchair Accessories

L0112 – L4631

Orthotic Supplies

SOFTWARE


Brightree


Provider Suite


Bflow Solutions

QUALITY CONTROLS AND MEASURES

To prevent the Denials / Non-payment in DME billing, below are the check points that we follow.


  • Verify insurance eligibility & coverage for the product before the product is delivered
  • Verify if Authorization is required or not
  • HCPCS Codes & Modifiers should be formulated perfectly
  • DME requires a prescription to rent or purchase, as applicable, before it is eligible for coverage
  • Submit all claims for repairs with a complete description of services provided
  • Bill on CMS 1500 (version 08/05) claim form & On-Time claims submission

Durable Medical Equipment Coding

Healthcare Common Procedure Coding System (HCPCS) is a standard code built for providers, in the medical industry for Health Insurances and Medicare. The DME is a complicated procedure as compared to the other medical billing issues. This type of situations falls under HCPCS Level II codes.


The Durable Medical Equipment billing is a procedure, and hence every step must be taken care of, failing, which can lead to a lesser chance of reimbursement. The code should be formulated perfectly, and the entities must be clearly and precisely defined.



Most common HCPCS codes used in Durable Medical Equipment billing

There are few frequently used HCPCS codes which target the problems coming under the Durable Medical Equipment billing. Some of the commonly used ones are below.


E0100 – E0159

Walking Aids and Attachment

E0163 – E0175

Commode Chair and Supplies

E0181 – E0199

Pressure Mattresses, Pads and Other Supplies

E0250 – E0373

Hospital Beds & Associated Supplies

E0424 – E0487

Oxygen Delivery Systems and Related Supplies

E0621 – E0642

Patient Lifts and Support Systems

E0950 – E1036

Wheelchair Accessories

MODIFIERS


From encrypting the information to give the details needed for any particular Durable Medical Equipment, modifiers can be used with HCPCS codes. A modifier is used to provide more information. There are many keywords that are used but below mentioned are some of the widely used modifiers.

  • RR – Rental
  • NU – New Equipment Purchase
  • UE - Used Equipment Purchase

CASE STUDY

  • One of our leading Client’s (Provider) , is a major supplier of Diabetic Shoe Inserts for whom we process 50 claims per day. Tricare had denied the Provider’s claims by stating them as non-covered services under Medicare. Provider generates 70% revenue from this product & 90% of their billing is associated with Tricare.
  • Provider was concerned as the impact of decline would result in a loss of USD $ 150k per month.
  • We diligently pursued our research against this decline and realised that the web portal of Tricare “health.mil portal” had that particular product listed and mentioned that it was necessary for Active duty members (military).
  • Based on these guidelines, we created our defense against the denial and had Tricare to reprocess all the denied claims for active duty members and had the claims reimbursed.

WORKFLOW

Ardur Technology is a Multi-Faceted organization offering diverse global business services like Title Insurance, Appraisal Services, Medical Insurance, Accounting

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