August 02, 2020 - BY Admin

DME Billing What are the Policy Developments



The United States Healthcare industry had changed in its true sense, and DME suppliers are seeking updates and information that would help them in the restructuring of revenue cycle, standardizing their businesses, and enhancing their coding and DME billing processes.


With the passage of the innovative US Medicare legislation, using Durable Medical Equipment was officially known by the congress. Hence, it is not a new development.

Since that time the DME billing law has witnessed tremendous amendment that will give room for a more desirable, economical, and workable crossing point among the user communities, suppliers, and administrative.

Consequently, discussed below are some of the Policy developments that happened in the areas of repairing or purchasing, renting, and maintenance of DME or Durable Medical equipment to ensure an ideal reimbursement.

Policy Developments for DME Billing


·         It is a rule of thumb that DME needs a prescription to buy or hire as the case may be, before it can be qualified for coverage.

·         Under the Capped Rentals, it is a must to rent particular items and may not be bought. In accordance to the new DME billing developments, some other particular items must be hired before they are changed to purchase.

·         After all HCPCS codes, the Medical Billers must charge the required modifier.

·         You are required to first charge repair and maintenance modifier after the process code as a DME biller.

·         It is also mandatory to tender all claims for repairs with a comprehensive explanation of services offered.

·         Always put forward a full narrative of items.

·         Tender a factory invoice for the item with your initial claim, bearing in mind that retail price listings and catalogs are not allowed. Plus a certificate of medical requirement form with the doctor’s signature, if suitable. You will lose reimbursement if you fail to abide by this process.

·         Avoid fastening the documentation to the claim form. Moreover, verify the EMR or HER prerequisites.

·         To be sure that the necessary documentation acknowledged in the same envelop, present all original claims on paper.

·         You cannot transmit the added documentation through claims submitted electronically.



Rentals DME Billing Requirements


·         Always take account of modifier code on all rental claim forms.

·         Show the commencement and closing dates of the rental time.

·         In the first modifier location of the 24D field on the claims for rented items, always add the “RR” modifier. Items filed that has no “RR” modifier and rental dates will be regarded as acquisitions and therefore be refunded accordingly.

·          Bill or charge for only the services that have been offered to a member already.

·         Bill or charge in each 30 days of rental as a unit except it is classified to be a daily rental.

·         The claim of an item still being rented when the claim is made must indicate the commencement date of the rental and the last day of the billing cycle as the service closing date.



The Renting DME Guidelines


Durable Medical Equipment rental versus the purchase coverage depends on the prescribed article, the total cost (purchase Vs rental), the prognosis of the patient, and the time limit needed for making use of the equipment.

Bear in mind that the benefits of rented Durable Medical Equipment cannot be more than the contracted fee schedule or total cost of the Durable Medical Equipment. This is one critical DME billing Policy development. 

Items considered capped rental are rented to the tune of amount allowed for purchase.

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