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DME & HME
Medical Billing

Improve Your DME and HME Revenue Cycle Management &
Get Rid of Your Headache

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Simple & Optimized Process to Improved Revenue Cycle

Navigating complexities in healthcare reimbursement, especially concerning durable medical equipment or home medical equipment, presents unique challenges due to stringent regulations and complexities in DME/HME specific coding and billing. We recognize these challenges and issues with adequate knowledge in durable medical equipment and supplies, and our expertise in the intricacies of DME/HME medical billing, HCPCS level II coding and documentation requirements to ensure precision and proficiency in your billing process.

At RCM Workshop, we are committed to maximizing reimbursements swiftly and maintaining the financial well-being of your business, guaranteeing the highest level of accuracy and full compliance in your billing process.

Unbeatable Service, Quality & Price

ACCURACY
0 %
TURNAROUND TIME
< 0 Hours
COLLECTION
0 %
PRICE
Starting from $ 1100 /Month

What Is Durable Medical Equipment (DME)

Durable Medical Equipment (DME) is a collection of medical devices that prevent injury, improve function, and alleviate pain or aid healing. Patients in the primary care setting commonly need these assistive devices. DME can be used repeatedly for medical purposes and is appropriate for use within the home.
Medicare Part B (Medical Insurance) covers medically necessary DMEs if prescribed by a physician or other health care provider, such as a nurse practitioner, physician assistant, or clinical nurse specialist. The Medicare Advantage Plan also covers DMEs like Original Medicare (Part A & B), which fall under the medically necessary category.
DME billing involves submitting claims for DME and supplies and receiving payment from the insurance company. Please click the following link to learn more about our DME billing services.
DME Billing

What is Home Medical Equipment (HME)

Home Medical Equipment (HME) refers to medical equipment appropriate for a home environment and can be managed by a patient or caregiver. HME services use durable medical equipment, but it encompasses many facets and is uniquely tailored for use at home. It includes everything required to assist patients in safely maintaining themselves in their places of residence. HME services have many distinct parts that must be recognized and paid for. The HME service providers must ensure accurate instructions for operating and maintaining HME items.
The patient’s healthcare insurance, including Medicare (Part B), typically covers home medical equipment. Medical billing for Home Medical Equipment involves several steps, from order intake to claim submission and payment collections. To learn more about HME billing, please click the following link.
HME Billing

CHALLENGES

Challenges in DME & HME Medical Billing

DME/HME medical billing differs from a standard medical billing process on several criteria such as billing workflow, codes, and documentation requirements. A DME is supplied to the patient only when a physician prescribes it and a comprehensive written order is necessary to initiate the Order Intake process. Order intake and confirmation process is a time-consuming task and need to be carried out according to billing guidelines and compliance requirements.

Durable Medical Equipment covers a wide range of medical equipment like wheelchairs (manual and electric), traction equipment, CPAP, canes, crutches, walkers, kidney machines, ventilators, oxygen, monitors, pressure mattresses, lifts, nebulizers, incontinence supplies, infusion therapy, hospital beds etc. It is important to have adequate knowledge of the equipment, whether purchased or rentals to create and submit claims.
HCPCS level II coding and proper use of modifiers (purchase vs. rental) are important to avoid denials. DME billing requires stringent compliance and documentation for an optimized and efficient billing process. Our expert billers with experience and knowledge in DME / HME billing will ensure guaranteed improvement in your billing process and outcome.

OUR PROCESS

Our DME & HME Billing Service Workflow

Backed by a team of dedicated and skilled coders and billers, our DME/HME medical billing service comprehensively addresses all your billing needs ensuring swift and accurate payments. Our end-to-end DME billing process covers every billing task from pre-billing services such as order intake, eligibility verification, prior authorization, and order fulfilment to post-billing services encompassing claims creation, submission, payment posting, denial management, and AR follow-up. Our billing experts follow-up with doctor office and patient, confirm order, schedule delivery, and coordinate with patients, ensuring a seamless DME revenue cycle.

We prioritize extensive quality audits and reviews, and meticulously organize documents at every stage of the revenue cycle to achieve timely and high-quality outcomes. Our analytics driven approach helps us monitor, measure and manage every billing process based on key performance indicators (KPI). Our metrics driven reporting tool captures and reports every aspect of process performance – productivity, quality and $ collections in a transparent way and gives you full control over your billing process.

Order Intake

Capture and document the details of equipment orders, patient, provider and insurance information after receipt of Rx / Order.

Eligibility & Benefits Verification

Confirm patient primary and secondary insurance and benefits coverage for DME and supplies, and check authorization requirement for the DME.

Prior Authorization

Initiate request for prior authorization with the payer, follow-up to check status till closure and finally update the system with approval reference number.

Doctor’s Office Follow-up

Regular follow-up with ordering physician’s office to gather various documents like Rx, CMN etc. to fulfil DME specific billing requirements.

Delivery Scheduling & Arrangement

Coordinate with supplier and patient for delivery of DME and generate delivery tickets and communicate with patient.

Order Confirmation

Verify all order details and patient information, and confirm DOS after receipt of Proof of Delivery.

Code Review & Charge Entry

Check accuracy of HCPCS Level II codes and modifier and assign corresponding and appropriate charges to the codes.

Documentation Audit and Review

Gather all documents needed as per DME specific guidelines and thoroughly review those before claim submission.

Claims Edit & Submission

Audit the claims thoroughly to check for accuracy and edit if necessary and submit claims – both EDI and paper format.

Payment & Denial Posting

Carry out both auto as well as manual posting for payments received and conduct reconciliation against claims.

Denial Management

Analyse and categorize denial claims according to denial codes, $ amount and payers, and resubmit claims after correction.

AR Management

Based on aging report, track and monitor unpaid claims; follow up with payers to gather status for claims, and their resolution.

Patient Collection

Sending patient statements and follow-up with patients for final and outstanding payment.
You can confidently rely on us to manage your entire billing process, or you have the flexibility to select specific DME billing services that suit your needs, ensuring a seamless operation without any interruptions.

BEST PRACTICES

Our DME & HME Billing Best Practices

Leveraging data analytics and a thorough analysis of denial trends in DME billing, we have established a foundation of best practices to ensure a seamless support for your billing requirements and operations. Our proficiency in healthcare revenue cycle management significantly contributes to streamlining DME billing processes and ensures full compliance with DME specific billing regulations.
  • Ensure correct documentation and establish medical necessity
  • Comprehensive eligibility and benefits verification
  • Effective prior authorization process to obtain prior approval proactively
  • Proactive follow-up with doctor’s office
  • Thorough review for HCPCS level II codes and modifiers
  • Efficient denial management and proactive claims follow-up with payers
  • Accurate payment adjustment, write-off and reconciliation
  • Stringent quality audit at every stage of billing cycle to ensure accuracy

BENEFITS

Outcomes guaranteed

Our DME medical billing process follows industry standard best practices and assures a consistent and exceptional outcome. Our methodical and diligent approach in performing billing tasks at every stage of billing cycle, from intake to claims submission and collection, ensures improvement in financial outcome and full compliance.

Correct documentation

<5% claims denials & improved compliance

Efficient insurance verification

>99% clean claim submission

Efficient authorization management

<24 hours turn-around time

Efficient HCPCS Level II coding & review

>25% increased reimbursement

Better coordination with doctor’s office and patients

improved Turn Around Time

Efficient denial management & AR follow-up

<5% claims denials & reduced aging

WHY US?

Why partner with us

Our DME billing service covers every aspect of your billing requirements that efficiently integrates with your current billing framework. Our team will work as an extension of your current setup and collaborate with you to fulfil your revenue objectives. We pride ourselves on delivering exceptional results, providing unparallel support to your business through our commitment to deliver what we promise. Collaborate with us today for exceptional outcome in your revenue cycle.

Guaranteed Improvement in Reimbursement and
Cash Flow

Reduction in denials
<5% and AR aging
<40 days

Transparent reporting
–NO BLACK BOX

100% data security
& HIPAA compliance

On demand scale up
of operation

Significant Reduction
in Cost > 75% Savings

Simple & No
Cost transition

Flexible & Unbeatable
Pricing Plan