Durable Medical Equipment provides assistance with treatment to patients. This equipment requires a valid prescription for claim settlements. It is not possible to claim covers on DME in any other way.
The durable medical equipment billing is not similar to the other medical billing process. Apart from regular checks, DME billing requires verification of the prescription. The eligibility of the company is also essential for settling claims.
Virtual healthcare helps in simplifying this process by automating the settlement process. This reduces the errors in the bill as well as completes the settlement process swiftly.
THE DME BILLING PROCESS
The DME billing process has 4 basic steps. Following these steps will make the settlement process simple. This will also lower the stress on the hospital staff.
Step 1 – The primary step is to prepare documentation. This ensures the medical necessity of the equipment. After verification of the prescription, the claim gets forwarded.
Step 2 – The patient has to now purchase the DME from the supplier. The patient receives the equipment only after a claim is successfully verified.
Step 3 – Assigning HCPCS Level II codes, the bills are then sent for a claim to the insurer’s company. Once all the paperwork concludes, the DME claim gets settled.
Step 4 – The A/R team does the follow-up and ensures that the claim gets settled on time.
MODIFIERS
An important feature in DME billing is the use of Modifiers. These are the codes that ensure the billing is proper. The most important points are –
- Establishing the necessity of the medical equipment.
- Complete documentation
- Proof of delivery of the equipment to the patient
- Ensuring the correct equipment and the service
- Mentioning the claim as per the requirement of the biller.
After ensuring the completion of the above points, the bills are generated. The 2-digit alpha coding/billing process requires knowledge and care while billing.
OVERCOMING CHALLENGES
The DME billing process requires to be free from errors. The errors in the bills delay the settlement time. The most common mistake and ways to overcome them are –
- Coding errors – This mistake generally happens due to manual billing. As the staff is generally overburdened with a lot of work, mistakes are common. This problem is overcome by using billing software. The bills are automatically generated on the basis of the equipment description. This greatly lowers the settlement time.
- Documentation – Incomplete documents are a major reason for delay. There may be mistakes in the documents. This again leads to delays in settlements. This process can again be simplified by using digital methods. Uploading data to the cloud will keep the data safe. This also makes it easily accessible.
- Regulations – There are frequent updates to the billing codes. In the case of manual billing, this becomes complicated. A lot of time is also spent analyzing the latest updates and applying them. A software-based billing gets updated easily. This means the billing process continues without much of a change.
- A/R management – The revenue cycle gets impacted severely if the A/R is not frequently checked. This leads to the accumulation of unsettled claims and an uneven revenue flow. Outsourcing the billing process to a company ensures that A/R is not left behind. Quickly settling the settlements ensures that the outstanding is as low as possible.
QUALITIES OF A GOOD BILLER
Hiring any biller will do no good. It is essential for the biller to have experience as well as the potential to handle the DME billing process. A few important qualities to look for in a medical biller are –
- Budget-friendly – The medical billing company should not burn a hole in your pocket. It is obvious that the company will ease the billing process, but this should not lower your overall revenue. The billing company should have the ability to implement changes and keep the revenue of the institute at a steady growth pace.
- Improved customer experience – The billing process is a complex process for the patients as well. It is therefore essential for the billing companies to ensure that the consumers do not face any problems. Responding to any customer query and completing the billing process on time should be a priority for the billing company.
- Data protection – Medial companies have access to sensitive data of patients. It is the responsibility of the company to ensure this data is not intruded upon. The company should store only the required information and properly
CONCLUSION
The DME billing process simplifies medical billing. Avoid complications in the billing process, by using the latest software and outsourced billing. This will show a positive impact on your RCM. There will be a steady revenue flow.
At Virtual Healthcare, our team has the experience to handle all such complicated procedures. We will ensure that your DME billing process is simple and settlements are timely.