Durable medical equipment (DME) refers to equipment and supplies ordered by healthcare providers for daily or extended use. It includes items that usually have long-term usages, such as wheelchairs, hospital beds, and portable oxygen equipment.
In recent years, DME has increased in popularity, especially among the senior population. The increase in demand and continuous technological advancements have led to DME billing changes.
DME billing is the process of submitting and receiving payment from an insurance company for a claim concerning the use of a DME. It is a complex system that requires strict implementation, maintenance, and staff education on proper billing and medical coding to ensure the success of the DME provider. Errors in DME billing can cause delays in payments and enormous losses for the healthcare provider.
The following are the common sources of errors in DME Billing:
1. Patient Data Verification
It is essential to verify patient data in the DME billing process. DME providers must check the patient's eligibility and current plan coverage and status before providing any service. It is vital to catch minor errors in the names or how the forms have been filled in by either the insurance provider or the CMS.
2. Medical Necessity
The DME billing documentation must be supported by proof of medical necessity. The inability to provide supporting documents to justify that the services billed were medically necessary according to payment policies can cause claims denial or rejection.
3. Insufficient Documentation
In DME billing, the inability to provide the sufficient and correct information in the documentation in the following aspects can lead to claims rejection or denial.
Incomplete form
Missing physician’s signature
Record of services provided
Improper mentioning of dates
Inability to bill each date of service separately
DME providers should strictly follow the documentation process to reduce denials. Insufficient documentation leads to losses not only for the DME provider but also for the Medicare Trust Fund.
4. Usage of Modifiers
Modifiers provide a description of the DME item. It indicates whether the item is new, used, or rented on a capped basis. Modifiers determine how medical claims are processed. Using incorrect modifiers or misaligned codes can lead to rejecting or denying claims.
5. Medical Coding Mistakes
Medical coding plays an essential role in DME billing. It has been identified as one of the primary sources of errors in the billing process. Incorrect use of medical codes would reflect an inaccurate service. Thus, it is crucial to ensure the accuracy of medical codes before submitting a claim.
The following are the most common mistakes to watch out for:
Report Misinterpretations - The use of codes when no DME service descriptions are provided.
Upcoding Errors - Occurs when patients are billed for more expensive and more complex procedures than what was received.
Unbundling Errors - The breakdown of DME procedures into smaller ones when there is one comprehensive code for the entire procedure.
Lack of Specific Code - There is a need for an additional specific code, but none was provided.
Inadequate Data - This occurs when healthcare providers fail to provide the correct and complete information.
Outdated References - DME codes are updated regularly. DME billing system and references must be updated as the DME codes are updated to prevent errors and claim denials.
Duplicate Billing - This human error requires the resubmission of a claim rather than filing a follow-up claim.
How To Avoid Errors In DME Billing:
Billing errors can cost DME providers a lot of money, especially if they occur regularly. Thus, it is important to take concrete measures to prevent these mistakes. DME providers must ensure that they have a highly-trained billing team that takes note of the common errors mentioned. A regularly updated DME billing system will also help detect mistakes and irregularities in the claims before submission.
Procurement and maintenance of a DME billing system and skills training for the DME billing team can be costly. A better and more cost-efficient option to reduce DME billing errors would be to outsource the process to a group of experts such as Proclaim Billing Services.
Proclaim Billing Services is the leading DME, Prosthetic, and Orthotic billing expert with years of practical experience in applying business processes. Hiring their team will be your best choice if you are a DME healthcare provider looking for experience and expertise in managing your Accounts Receivable, Collections, and Claims Processes. Entrusting your DME billing process to Proclaim Billing Services will significantly reduce billing errors, claims denials, and rejections and reduce your workload, allowing you to focus on caring for your patients.
Set an appointment today to learn more about how Proclaim Billing Services can assist your practice.