Medical Billers and Coders

  Improper Payment Reasons Durable Medical Equipment (DME) suppliers of surgical dressings and physicians submit claims for surgical dressings and CMS covers it under the surgical dressings benefit i.e., SSA Section 1861[s][5]. CMS recently published Medicare Fee-for-Service (FFS) improper Medicare payments rate for surgical dressings for the 2020 reporting period. For this reporting period, the improper payment rate for surgical dressings was 67.3 percent, with a projected improper payment amount of over $194.9 million. For the 2020 reporting period, insufficient documentation accounted for 82.4 percent of improper Medicare payments for surgical dressings. Additional types of errors for surgical dressings in the 2020 reporting period were no documentation (1.9 percent), medical necessity (1.7 percent), incorrect coding (1.9 percent), and other (12.2 percent).  Avoiding Improper Medicare Payments All claims billed to Medicare require a written order or prescription from the treati

ICD-10 and DME Billing DME billing is the process of submitting and receiving payment for a claim from the insurance company. Implementing, maintaining, and educating staff on proper billing is vital to a DME provider’s success. The challenges facing Durable Medical Equipment (DME) organizations with the upcoming ICD-10 coding system are plenty. Although the DME you bill for will still employ the same HCPCS codes, the actual difference will be in the diagnosis coding itself. Firstly, the transition from ICD-9 to the new ICD-10 coding system has led to an increase in the number of codes for procedures from 3,824 to 71,924 and simultaneously has also increased the number of codes for diagnosis from 14,025 to 69,823. Secondly, there are few one-to-one, cross-walked codes in the ICD-10 Thirdly, it is a known fact that the DME providers receive meager information from the physician to convert the codes accurately thus leading to delays in claims causing a shortage in cash flow. Fourthly

  Long-standing concerns in DME (Durable Medical Equipment) known for unquestionable billing practices, led the government to take action for tackling fraud in the insurance industry. Medicare, the nation’s largest health insurance program, regulates the billing structure of the maximum number of healthcare providers. Due to its highly fragmented nature, Medicare is prone to widespread fraud thereby rising healthcare costs, taxes, and premiums. DME billing is  the process of submitting and receiving payment for a claim from the insurance company . Medicare pays for services given to the severely sick/disabled at home such as wheelchairs, arthritis kits, etc. But many DME companies supply cheap or bad quality equipment at good quality equipment rates to make profits or sometimes bill Medicare for equipment never provided. To crack down, on this fraud, the Centers for  Medicare & Medicaid Services  (CMS) issued new rules catering toward reducing needless consumption and aberrant b

  Durable Medical Equipment (DME) is equipment that includes oxygen supplies, wheelchairs, iron lungs, catheters, etc. As you are starting a Durable Medical Equipment (DME) company, be prepared with time on hand, money, endurance, and determination; as it ultimately boils down to being paid for the products sold by your company. This means receiving DME bills from clients (patients/healthcare providers) and accepting the insurance, billing the insurance, and finally receiving payments for the  DME billing  from the insurance provider- is called  Credentialing For DME  Companies. DME business also referred to as Home Medical Equipment business is replete with potholes along the way which need to be cleared. One of them is ‘ Provider Credentialing .’ Credentialing simply denotes verification. It’s also known as DME credentialing, DME medical credentialing, DME provider enrollment, insurance credentialing, or getting on insurance panels. These terms imply that the patient is going to p

On 4 th  April 2022, CMS published a rule on “suspension of prior authorization requirements for orthoses prescribed and furnished urgently or under special circumstances”. Prior authorization helps Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers ensure that applicable Medicare coverage, payment, and coding rules are met before DMEPOS items are delivered. The prior authorization program helps to protect the Medicare Trust Fund from improper payments while ensuring that beneficiaries can receive the DMEPOS items they need in a timely manner. CMS maintains a master list of DMEPOS items that requires either a face-to-face encounter and written order or prior authorization requirements. You will find the updated list  here . Due to the need for certain patients to receive an orthoses item that may otherwise be subject to prior authorization when the two-day expedited review would delay care and risk the health or life of the beneficiary, CMS suspended pri

Durable Medical Equipment (DME) Billing   is different from the other   medical billing   and   coding   for the specialties. Unlike the other coders and billers who work on DME need specialized training to deal with different medical situations and equipment that require different types of modifiers as requested.  DME billers need specialized in-depth, specialized knowledge of different types of HCPCS Level 2 codes. Let’s understand the procedures of coding that can be implemented to make the billing process more effective: ICD-9 codes are 3-5 digits in length and speak to the patient’s conclusion CPT restorative charging codes are in fact HCPCS Level I codes. They are 5 digits in length and speak to the methodology performed at the patient’s visit HCPCS codes are in fact HCPCS Level II codes. They incorporate the two numbers and letters and are likewise 5 digits in length. These codes speak to the majority of the provisions or gear utilized in the patient’s consideration. All Durable

Durable medical equipment billing is that the process by which insurance companies are charged for the services provided to their clients. And in order to achieve the complete reimbursement dollars billing codes that represent different aspects of the DME process are implemented. The characters, the biller enters relate to different aspects of a diagnosis or procedure and permit the information to be uploaded for billing without having to physically define either diagnosis or procedure. This allows the method to be implemented faster without having to explain everything intimately. When we mention specialization consideration in DME suppliers' one specialty that always crosses the supplier's way is Orthopedics. Orthopedic facilities often provide patients with supplies, such as casting and canes, which are integral to patients' treatment plans. What DME supplies are often used for orthopedic treatment and the way to charge for them? The Current Terminology Codes (CPT) publ