#1 in DME Billing

With decades of specialized expertise in DME billing, combined with best-in-class technology solutions and unparalleled transparency through data analytics, we empower DME companies to achieve a sustained increase in collections.

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  • We work as a department of your practice
  • We help reduce compliance & denial risks
  • We help increase your practice revenue
  • We help improve patient experience
Physician Credentialing

Evan Hovek
DME Billing Pro Services Expert


#1 in DME Billing

With decades of specialized expertise in DME billing, combined with best-in-class technology solutions and unparalleled transparency through data analytics, we empower DME companies to achieve a sustained increase in collections.

  • We work as a department of your business
  • We help reduce compliance & denial risks
  • We help increase your payments and revenue
  • We help improve patient experience
Physician Credentialing

Evan Hovek
DME Billing Pro Services Expert


Why consider us?

We partner with HME/DME companies with a tailor-made approach designed to streamline the medical billing process to increase payments, enhance patient experience and improve compliance.

Experts in HME/DME Billing

With 200+ years of HME/DME billing experience, we understand the uniqueness of HME/DME billing and coding.

Improve End-to-End Billing Process

We optimize the process from order intake to posting the payments and bring technology tools to improve end to end billing workflow.

Driven by Data & Analytics

Our proprietary reporting and analytics provide insights that help minimize AR, denials and maximize revenue.

Our Services

We provide comprehensive services to DME/HME companies and manage end to end medical billing process.

Document Medical Necessity​

Documentation from the provider on establishing the medical necessity is very critical in the billing process.

Obtain Prior Authorization

Some items require prior authorization, We request prior authorization before providing supplies to avoid denials.

Insurance Verification

Before fulfilling the order, verifying the patient's insurance information will minimize denials.

Ensure Accurate HCPCS Level II Codes​

An accurate HCPCS Level II codes is very important to reduce denials and receive proper reimbursement.​

Claim Submission

Submit claims with all of the necessary documents to prevent denials.

AR Follow-Up

Follow-up on open claims over 30 days from the payors.

Payment Posting

Posting payments against the claim and reconciling the funds received. Both electronic and manual.

Patient Satisfaction

Support the patients regarding delivery or usage of the equipment, or the patient statement.

Reporting and Analytics

Create and review reports such as Charges, Payments, AR, Denials, and Cashflow.

Denial Management and Appeals

Denials are detrimental to the financial health of most DMEs. Some denials require an appeal. Denials need to be properly handled for financial success.

Support during Medicare Audit

Often times, HME/DME companies are subjected to Medicare audit.

Credentialing

Getting in network with commercial payers can increase revenue.

What Our Clients Says?

FAQ's

Frequently Asked Questions about HME/DME Billing

DME, which stands for “Durable Medical Equipment,” is important for various reasons, particularly in the context of healthcare. DME refers to medical equipment and devices that are designed for repeated use by patients or healthcare providers. Here are some reasons why DME is important:

  1. Enhances Patient Independence 
  2. Supports Rehabilitation
  3. Manages Chronic Conditions
  4. Facilitates Home Care
  5. Improves Safety and Functionality
  6. Cost-Effective Healthcare

The DME (Durable Medical Equipment) billing process involves several steps to ensure accurate reimbursement for the provision of durable medical equipment and related services. Here is a general overview of the DME billing process:

  1. Patient Assessment and Prescription:

    • A healthcare professional assesses the patient’s condition and determines the need for durable medical equipment.
    • A prescription or order is provided by an authorized healthcare provider, specifying the type and quantity of DME required.

  2. Patient Information and Eligibility Verification:

    • Collect patient demographic information, insurance details, and prescription information.
    • Verify the patient’s eligibility for DME coverage with the relevant insurance or payer.

  3. Documentation:

    • Ensure that all necessary documentation is complete and accurate. This may include the prescription, medical records, and any other supporting documentation required by payers.

  4. Medical Coding:

    • Assign appropriate medical codes to the DME items and services using standard coding systems (e.g., HCPCS – Healthcare Common Procedure Coding System).
    • Accurate coding is crucial for proper reimbursement and compliance with billing regulations.

  5. Claim Creation:

    • Create a claim that includes patient information, provider information, DME details, and coding information.
    • Include any required modifiers or additional information specified by payers.

  6. Claim Submission:

    • Submit the claim to the relevant insurance company or payer using the appropriate billing format (e.g., electronic claims submission, paper claims).
    • Follow the specific submission guidelines of the payer.

  7. Adjudication:

    • The payer reviews the claim for accuracy, completeness, and compliance with policies and guidelines.
    • The claim may be accepted, rejected, or denied based on the review.

  8. Payment and Remittance:

    • If the claim is approved, the payer issues payment to the DME supplier or healthcare provider.
    • The remittance advice provides details on the payment, adjustments, and reasons for any denials.

  9. Appeals Process (if necessary):

    • If a claim is denied, the DME supplier or healthcare provider may go through the appeals process to challenge the denial and provide additional information or clarification.

  10. Record Keeping:

    • Maintain thorough records of all transactions, including patient documentation, claims, remittance advice, and any communication with payers.

Optimizing Durable Medical Equipment (DME) billing requires adherence to several best practices to ensure a smooth and efficient process. Accurate documentation is paramount, encompassing comprehensive patient information, prescription details, and supporting documentation to validate medical necessity. Verification of patient eligibility and coverage with the respective payer prior to providing DME services is crucial to prevent claim denials due to eligibility issues. Keeping abreast of up-to-date coding and employing modifiers judiciously helps convey essential information and ensures accurate reimbursement. Familiarity with payer policies is essential, as different payers may have unique requirements and compliance is integral to successful reimbursement. Timely claim submission, preferably through electronic means, minimizes delays and errors. Ongoing training for staff, regular monitoring and auditing of internal processes, and the utilization of technology to streamline billing procedures contribute to a robust billing system. Effective communication with payers, a structured appeals process for denials, and staying informed about regulatory changes further enhance the efficiency and effectiveness of DME billing practices.

 

A billing company plays a crucial role in the success of a DME business. The billing company assigns the appropriate HCPCS Level II codes and submits the DME claim to the payor. It might be very hard for the DME companies to keep up with the CMS changing regulations. DME billing company plays a critical role in keeping the DME business compliant and support during Medicare audit. AR follow-up, payment posting and patient support are few other key activities that billing company do for the DMEs.

DME billing is unique as it requires a more in-depth knowledge of various medical situations and specialized DME items such as wheelcharis, walkers, oxygen equipments than traditional medical billing and coding requires.

DME billing has its own set of codes called HCPCS (Healthcare Common Procedure Coding System) codes

To obtain accreditation, the HME/DME companies get evaluated to detemrine if they meet certain standards defined by CMS of quality and competence by recognized organizations such as the Accreditation Commission for Health Care (ACHC) or the Healthcare Quality Association on Accreditation (HQAA) . The accreditation process may take 3-9 months.

Some times HME/DME companies are flagged for audit by Medicare in order to received Medicare Part B payments and to retain a supplier billing number. It is conducted by the CMS to reduce fraud, abuse, and improper payments of claims related to Durable Medical Equipment (DME). The audit process can take up to 3 months.

  • Incorrect or Inconsistent procedure codes: The HCPCS (Healthcare Common Procedure Coding System) codes used in the claim are inconsistent with the modifier or required modifier is missing
  • Incomplete documentation: The claim lacks information or has submission/billing errors such as missing/incomplete/invalid procedure code(s), missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure, missing Certificate of Medical Necessity, missing/incomplete/invalid place of service, and missing/incomplete/invalid principal procedure code
  • Missing ordering physician name: The item(s) billed did not have a valid ordering physician name
  • Missing ordering physician National Provider Identifier (NPI): The item(s) billed did not have a valid ordering physician National Provider Identifier (NPI) registered in Medicare Provider Enrollment, Chain and Ownership System (PECOS)
  • Incorrect payer information
  • Lifetime benefit maximum reached: The lifetime benefit maximum has been reached, billing exceeds the rental months covered, or payment cannot be made after the reasonable purchase price has been met
  • DME billing KPIs (Key Performance Indicators) are metrics that help DME providers measure the success of their business and identify areas for improvement. Here are some common DME billing KPIs:
  • Days Sales Outstanding (DSO): This metric measures the average number of days it takes to collect payment from the date of service 1.
  • Clean Claims Rate: This metric measures the percentage of claims that are processed without errors or rejections 1.
  • Denial Rate: This metric measures the percentage of claims that are denied by payers 1.
  • Collection Rate: This metric measures the percentage of billed charges that are collected 1.
  • Average Reimbursement per Claim: This metric measures the average amount of reimbursement received per claim 1.
  • Accounts Receivable (AR) Aging: This metric measures the length of time that claims have been outstanding and unpaid 1.
  • Revenue per Patient: This metric measures the average revenue generated per patient 1.
  • Patient Satisfaction: This metric measures the level of satisfaction of patients with the services provided
Physician Credentialing Service

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  • We work as a department of your practice
  • We help reduce compliance & denial risks
  • We help increase your practice revenue
  • We help improve patient experience
Schedule Free Consultation
Schedule Free Consultation