July 21, 2020 - BY Admin

How Durable Medical Equipment Billing is different from other Medical billing

Durable Medical Equipment (DME) billers should be adept in all HCPCS Level II codes since all the DME are comes under this category. These products are otherwise called as Home Medical Equipment (HME).

Durable Medical Equipment (DME) can withstand repeated use, and they can be bill either as rental or purchase. The decision of rental or purchase is based on the item prescribed and its category. 

Below are some of the Home Medical Equipment (HME) categories.

  • Inexpensive Routinely purchased items – IRP
  • Items Requiring Frequent and Substantial Servicing
  • Other Prosthetic and Orthotic Devices
  • Capped Rental Items
  • Oxygen and Oxygen equipment's

Each category of items has its own rules on how to code and bill the claims to Insurance.

Durable Medical Equipment (DME) billers usually have in-depth knowledge in these categories, and they should be aware of the billing guidelines for the below products.

  • Oxygen and Contents
  • PAP and Supplies
  • Hospital beds and their types
  • Wheel Chairs and their types
  • Bathroom equipment
  • Canes, crutches, and walkers
  • Traction and trapeze Equipment
  • Pneumatic Compressors and Appliances
  • Infusion Equipment and Supplies
  • Equipment related to wound care
  • Surgery items

and a lot more…

The significant denials we are receiving from the Insurance are Inpatient stays, Maximum benefits met, Related or qualifying service was not identified on the claim, Rental purchase guidelines were not met, No authorization, etc.

To avoid getting denials, the billers should go through every claim to ensure that the information is added as per the insurance guidelines before they are getting billed. 

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