Medical billing

Durable Medical Equipment Billing Guide: A Precise 3-Step Guide

Durable Medical Equipment (DME) billing is a special kind of billing which differs from traditional medical billing and coding.

The billers and coders who work with Durable Medical Equipment billing get a different kind of training so that they can deal with different kinds of medical problems and situations that require separate kinds of modifiers than the common ones in practice.

The billers working in Durable Medical Equipment billing are supposed to be specialized in different kinds of HCPCS level 2 codes.

We have come up with a Durable Medical Equipment billing guide to help you understand this special kind of billing in detail.

Durable Medical Equipment billing guide

The DME billing and coding process has 3 main steps which are as followed

1. Therapeutic betterment of the patient

The patient in question should be visiting a specialist who has determined that tough restorative hardware is essentially important for the therapeutic betterment of the patient.

For example, a tyke shows up at a practice of pediatrics stating that he is suffering from croup (a disease in which aviation routes irritate). The pediatrician will examine the patient and will verify the case by prescribing him a nebulizer for the regulation of steroid inhalation. This needs to be managed round the clock till the point that the patient starts feeling better. In this case, the medical expert will acknowledge the need for a nebulizer at home for the patient and will endorse it to the patient.

2. Get Provisions from the DME Provider

After the patient has visited the specialist and has been recommended medical equipment, the next step is to get provisions from the DME provider.

This means that the medical coder will find the relevant medical equipment or medicine and hand it over to the patient while charging it in the bill.

In certain cases, it might be possible that the patient needs a pre-approval. A pre-approval is required by the insurance company which can inspect the treatment and condition of the patient as well as the specialist’s recommendation of the DME supplies for utilization.

Durable Medical Equipment billing guide

Once all of this is processed, the DME provider can further dispatch the equipment to the patient. For instance, the nebulizer equipment, as mentioned in the above example, will be given to the patient by the DME provider. The providers will give out the hardware whereas the billers are supposed to handle the printed material of the billing as well as make sure that the patient receives the correct equipment. The procedure is the same when a patient has been prescribed a specialized drug.

3. Charging and Coding the Patient’s Bill

The third and final step is charging and coding the patient’s bill regarding the tough restorative hardware. The DME billing and coding team needs to be extra vigilant to put in the right code against the hardware provided to the patient as the copy of the bill will also be sent to the insurance company of the patient.

The coders need to put the correct codes of HCPCS Level II with the help of the HCPCS manual. This might look simple but in reality, it is the coder’s job to ensure that every extra gear has been coded and nothing is left out.

For example, the DME provider will not only send out a nebulizing machine to the patient but he will also provide the patient with air hose tubing. A face covering mask which differs for different ages. All of these three articles need to be billed separately and coded respectively.

Once the specialized bill has been compiled it is further sent to the higher officials to verify and approve the sent items. After the verification, the bill is forwarded to the insurance company in order to make payment for the specialized procedure.

It is very important to note that this specialized durable equipment is recommended by specialist physicians which is termed as therapeutically necessary for the betterment of the patient. They are once affirmed by the insurance company backing the patient and only when this specialized hardware is delivered to the patient.

Final words

The Durable Medical Equipment billing and coding processes are substantially different from the regular medical coding and billing process. They are specialized under the HCPCS Level II and under these specialized codes, the bills are compiled and charged to the patient.

It is important to hire experienced personnel who know how to charge and code durable medical equipment bills as the codes are specialized and require extreme focus and attention so that nothing is missed out from the final bill.