Making understand the therapeutic use of DME billing is crucial. Any member of insurance benefits with equipment to certain conditions that require repetitive use is DME. It will have a definitive purpose and any CPAP and BIPAP machines, devices in oxygen, ambulatory equipment, crutches, and cane fall under this category.
Suction machines and nebulizers, electric beds, feeding equipment and orthotics devices also come under its ambit. Hence, it is quite clear that the segment is vast and you need quality planning with your DME billing as a provider.
Get your by understanding the coverage in DME: Co pay is also a part of the coverage. Getting an innate idea about the general billing requirements is the key. The benefits provision and the members plan assessment will be a key criterion for processing improved DME billing claims.
Streamlining the documents and the letter of medical necessity particularly in the case of BIPAP machines, mattresses are critical. The perfect example will be the use of the CPAP machines that cannot be ordered more than once in a time span of 5 years.
Cycle in DME Billing:
A lot of activities are involved in DME billing and at the onset; it should begin with the order based entry based on Rx as will be fixed by the physician. Also, information on the provider history and the correct product code is extremely important. The eligibility verification process has to be timely with the correct interpretation of the Rx and the entry of Dx. Ensuring the right checks and balances that comply with the prior authorization requirements will be vital.
Assessment of payer requirements:
To realize consistency in reimbursements, it is pertinent to understand individual payer requirements in respect to annual cost limitations, time relation, and its frequency before the delivery of the equipment.
Receipt confirmation is the cornerstone of medical claims submission after the generation of the delivery ticket. A competent vendor specialized in DME billing with a complete knowledge of the claims adjudication priorities will surely provide the added edge to a DME provider.