Why Should You Outsource DME Billing?
DME billing services can be quite complex because they involve ever-changing coding requirements (like HCPCS Level II codes) and compliance regulations set by CMS and private payers. They also include many details from other inter-linked specialties like prosthetics, physical therapy, geriatrics, orthotics, and services for long-term care or disabled patients. Medcare MSO’s experienced billing team streamlines the claims process, ensures revenue integrity, and facilitates clean claim rates. Our proven system and dedicated focus on billing and the medical revenue cycle allow us to guarantee an accurate and efficient billing process that supports your durable medical equipment reimbursement needs.
The Complexity of DME Billing Codes
Durable medical equipment billing stands apart from typical medical claims management due to its unique set of coding challenges. Whether it’s for a walking aid or a respiratory machine, each equipment category demands specific HCPCS (Healthcare Common Procedure Coding System) codes. This complexity often leads to claim denials or billing errors when handled in-house. At Medcare MSO, we have a dedicated DME billing team that understands these specialized codes and how they intersect with payer-specific rules such as Medicare Part B, Medicaid guidelines, and commercial plan limitations. This allows us to minimize rejections and accelerate cash flow for your practice.
Outsourcing Medical Billing for an Efficient DME Billing Process
DME Medical Billing Has Unique Challenges
DME billing services have to manage a range of complex requirements beyond the basic CPT/HCPCS coding that is part of all healthcare billing. From modifier usage (e.g., NU, RR, KX) to payer-specific documentation requirements and local coverage determinations (LCDs), each DME claim has its own set of compliance checkpoints. Medcare MSO offers the specialized knowledge and tech-enabled systems needed to navigate payer portals, submit error-free claims, and recover the maximum allowable reimbursement.
DME Billing Has Different Rules for Rentals vs. Purchases
Some durable medical equipment is available for rental, but certain items must be purchased. And then there are some things that can be purchased after a trial rental period. Insurance carriers — including Medicare, Medicaid, and commercial plans — have varying policies regarding these categories. Adhering to rental modifiers, tracking rental cap limits, and understanding DME POS billing guidelines are all critical for claims approval. Medcare MSO ensures seamless handling of rental vs. purchase billing workflows, relieving your staff from the administrative burden.
Customized Equipment Requires Specific Documentation
Customized equipment, such as complex rehab wheelchairs or custom-fabricated orthotic devices, necessitates additional documentation for billing. This often includes clinical notes, Certificate of Medical Necessity (CMN), and factory invoices. Our team is proficient at compiling and verifying all necessary paperwork to submit a fully compliant claim, ensuring there is no delay in reimbursements or denials due to insufficient documentation.
DME Billing Companies Must Be Aware of Warranty Statuses
Tracking the warranty status of equipment is crucial when submitting claims for repairs or replacements. If the item is under warranty, the manufacturer — not the payer — is responsible for servicing. Providers may only bill payers if the warranty has expired, which means having a real-time inventory and warranty tracking system is essential. Medcare MSO incorporates this into your billing workflow, confirming warranty eligibility before claim submission to avoid insurance rejections.
