Billing for Durable medical equipment services

Understanding Billing for DME Services or Durable Medical Equipment Services

Many of our blog readers will contact me and ask why is it too complicated to be billing for durable medical equipment?

Actually it is not complicated, you just need to understand how it works.

Here are some pointers that I would like to point out to you:

• Verify the Necessity of the Durable Medical Equipment
  • a Detailed Written Order or Prescription fully signed by the referring/rendering/servicing provider must be on file
  • look at the provider's treatment plan 
  • if this is indicated due to accident or injury related case, include the date of incident
• Credentialing
  • is it the Physician Practice billing for the DME? (Medicare require that you have completed and been approved. Look at form CMS-855s.)
  • is it a DME Company billing for the durable medical equipment? (you need to be fully credentialed and identified as a DME Vendor by the payers including that of Medicare) - you don't have to be contracted with the insurance payers.
  • You can be out of network vendor or provider with the commercial insurance (not with MEDICARE!) but be careful making sure you have informed your patient that you are out of network provider. Inform the patient about their estimated out of network financial responsibility
• Make sure you have checked the patient's benefits and eligibility for the particular DME or Durable Medical Equipment
  • watch for its utilization policy and guideline. For example, Medicare Beneficiaries cannot get the same Lumbar Orthosis within the last 5 years
  • watch for medical necessity diagnosis cross over
• Make sure you understand the difference between billing out of network and in network

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Pointers on DME Billing Services and Coding

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• ​Make sure you are reporting the correct HCPCS code(s) that best describe the DME or Durable Medical Equipment
• Make sure you are reporting the correct place of service and correct DME Billing services modifier(s)
• Make sure that your billable date of service should be the date you have dispensed the DME or Durable Medical Equipment to your patient and also that same day the patient had signed receipt of the DME. DO NOT bill based on the date of when you prescribed the DME, I think this is inappropriate
• If the date of service is for a rental and are in range of dates, make sure you verify with your insurance payers how do they want it reported. For example;
  • ​does one month rental equal 21 days? or 30 days? 
  • are you reporting from start to end date and report the number of units as days?
  • are you reporting the same date of service for start and end date? 
  • check your modifiers used for DME Billing Services
• Keep a copy of your patient's signed receipt that they have received the DME service
• Document the necessity of the durable medical equipment

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Other related blog posts:

DME Billing Modifiers

Physician Medical Billing Denial Management

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