Durable Medical Equipment is a vast and lucrative industry. However, due to its ever-changing regulations and its complex DME codes, fee structure, etc today many providers are struggling to manage it efficiently.
The DMEPOS file rules in fact are made with the goal to provide better accessibility, quality, affordability, empowerment, and innovation for a healthcare system.
In fact, last year itself on the 21st of December, 2021 in order to strengthen Medicare by expanding access to certain durable medical equipment, such as continuous glucose monitors that increase diabetes treatment choices for people with Medicare, the Centers for Medicare & Medicaid Services (CMS) issued a final rule.
These types of regulations are at times missed and practices that are not updated end up making errors in the DME billing process.
Furthermore, a biller should not only be aware of the billing process but need to have an understanding of the different payor requirements and DME billing needs and most importantly required fee schedule amount for better billing operation.
Fee schedule details amount for the area within the Contiguous United States – the adjusted fee schedule is the average of Single Payment Amounts from CBPs from 8 different regions of the contiguous United States.
This process also applies to enteral nutrition and most competitively bid DME items manufactured and sold in the contiguous United States, which is also included in more than 10 Competitive Bidding Areas (CBAs).
And for fee Schedule Amounts for Areas outside the Contiguous United States – areas like Alaska, Guam, Hawaii outside the Contiguous United States are based on a mix of 50% of the adjusted fee schedule amount and the remaining of the unadjusted fee schedule amounts updated by the covered item updates specified in Sections 1834(a) (14) and 1842(s)(B) of the Act.
The job of billers doesn’t end here, as the billing process involves, the coder further needs to update all the new codes.
Keeping in mind all about the documentation needed like – correct patient information, demographic, etc, a biller for claims management further needs to submit- the ‘UB’ modifier, as well as the Submitted Charge which must match the amount on the invoice ( excluding A9901 ) and more according to the billing requirement.
With so much to remember and so much confusion, you need the right external support to help you maintain your DME billing operation. This is why today, healthcare practices end up opting for expert guidance – ‘outsourcing’.
Helping you with a better billing approach, outsourcing RCM organizations are not only aware of the present industry mandates but are up to date with DMEPOS billing rules, codes, and different payor’s requirements. Taking care of your complete pre and post DME billing and collection, and partnering with an operational extension aid you with reduced operational extension and decreased billing and coding errors.
With a better claims and accounts receivable management process, there is an outsourcing RCM destination that ensures 97 % highest collections rate and faster reimbursements.
In fact, in this challenging time, when healthcare costs are rising and billers and coders are rare, the outsourcing option is the best cost-effective alternative for many DME providers.