DME Billing Services: Maximize Payment, Minimize Denials

Outsourcing Medical Billing for an Efficient DME Billing Process

DME billing is a big part of medical billing and coding. HCPCS Level II codes capture non-physician services, supplies and durable medical equipment. Med Billing RES’s certified DME billing specialists know the unique coding requirements of DME. Partner with us to get paid more, increase patient satisfaction and focus on what matters most patient care.

Complex Coding:

CMS updates HCPCS Level II codes for DME in medical billing every year medical billers need to update codes These complexities can impact claims big time and requires attention to detail.

HCPCS Level II Codes: DME claims rely heavily on Healthcare Common Procedure Coding System (HCPCS) Level II codes. These codes are alphanumeric and are used to identify products, supplies and services not covered by CPT codes.
Specific codes for specific items: Each piece of DME has a specific HCPCS code to categorize its use, type and medical necessity. For example, a semi-electric hospital bed with head and foot adjustment uses code E0260 while a CPAP machine is coded E0601.
Different codes for renting or purchasing: DME billing allows for both renting and owning equipment and specific codes are designated to distinguish between the two.
Modifiers: Modifiers are important in DME billing and provides additional information about the item and its use. Modifiers can indicate factors such as rental periods (e.g. first month rental), medical necessity or extended use. Incorrect use or omission of modifiers can lead to claim denials.

Documentation complexities

Accurate documentation is the foundation of DME billing compliance. This includes:

Detailed physician orders: also known as a Standard Written Order (SWO) or Detailed Written Order (DWO), is a document that confirms what a physician has prescribed for a patient. Must be signed, dated, specify the exact DME, patient’s diagnosis, patient information, physician information, length of need and any special instruction. For DME drugs under the DME benefit the order must also specify: drug name, dosage/concentration, duration, quantity and refills.

The detailed physician order acts as a bridge between the physician’s prescription and the DME supplier’s billing process, so the right equipment gets to the right patient and the claim is properly supported for reimbursement.

Prior Authorization

Streamlined prior authorization (PA) in Durable Medical Equipment (DME) billing refers to optimizing the process of obtaining approvals from insurance payers before providing DME items to patients.

Time consuming
Complex
Frequent updates
Manual processes
High denial rates

Denial Rates

Frequency: 20-30% of DME claims are denied initially, that’s how prevalent errors in documentation and coding are. One industry report says up to 20% of all medical claims are denied on the first submission.
Impact: Denied claims requires costly and time-consuming rework, average cost of rework is $118 per claim for complex DME cases.
Causes: Common reasons for DME claim denials are inaccurate coding, insufficient documentation (missing patient info or prescription), no prior authorization, insurance coverage issues.

Also using outdated coding resources and not meeting specific payer requirements contributes to denials.

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DME Billing Services: Maximize Payment, Minimize Denials

Outsourcing Medical Billing for an Efficient DME Billing Process

Complex Coding:

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