DME Billing Services Archives - InfoHub https://infohubservices.com/blog/category/dme-billing-services/ Thu, 22 Sep 2022 14:14:40 +0000 en-US hourly 1 https://wordpress.org/?v=6.1.1 https://infohubservices.com/wp-content/uploads/2019/10/cropped-INFO-HUB--32x32.png DME Billing Services Archives - InfoHub https://infohubservices.com/blog/category/dme-billing-services/ 32 32 3 Powerful Strategies to Drive your DME Billing https://infohubservices.com/blog/3-powerful-strategies-to-drive-your-dme-billing/ Mon, 19 Sep 2022 13:48:48 +0000 https://infohubservices.com/?p=46924 Making sure the revenue cycle management is efficient is one of the cornerstones of the success of any DME facility. It also has a direct bearing on your service’s patient experience and your capacity for boosting the facility’s performance. Additionally, effective revenue cycle management enables you to cut errors and service expenses overall. However, without a qualified DME billing company, this is not feasible. A reliable offshore DME billing company will help in reducing errors, streamline the recordkeeping, billing, and coding process, and assist your DME facility in adhering to the most recent revenue cycle techniques for DME pricing and coding standards.

In order to boost the ROI to the highest levels, suppliers are now looking to increase their customer’s loyalty and satisfaction program. Low payments, modifications to medical rules, and all these present serious difficulties. Nowadays, more patients pay out of their pockets or do not know that however much they owe. The last thing a DME supplier wants after working arduously to deliver the equipment to the patient’s door is to have their payments rejected.

One of the biggest problems in the services is the DME industry’s reputation for undergoing ongoing modifications. The cost of employee training, decreased collections, billing mistakes, and suspension of operations due to staff absence are just a few of DME’s many issues. Any of these issues has the potential to reduce both the service’s overall productivity and its income.

Knowing the three-step financial approach to increase your DME income is urgently needed. Let’s quickly review each of these steps.

1. Verify the Legitimacy of the Insurance before Delivering it

By validating and proving insurance within a day or two before the planned insurance appointment, you can increase your charge-to-collection ratio. You can cancel the already planned appointment if you have any reservations about the insurance plan. Here’s a quick and simple method for checking your insurance:

a) Make a call to check on the insurance’s status.

b) EMR or billing software verification are both options.

c) Check your Payers coverage using online resources. Your time and effort can be used for more vital activities by outsourcing the verification process to a specialized DME billing company.

2. Timely Payment of Service Fees

You might not be aware of it, but the possibility of your collection falls by more than 45% after a patient departs your hospital. The co-insurance as well as co-pays, in addition to any previous dues and expected deductibles, must therefore be collected after the equipment has indeed been given. Therefore, it’s usually a good idea to have a thorough check-out procedure in place so that you can gather before the patient departs the hospital. There are many technology-based possibilities for modernizing the RCM process. Payment variance software, for instance, can assist you in determining the tendency of excess or underpayment. It might help your DME to generate a steady income. Some tools, such as integrity tools, can aid in boosting revenue. The tiresome, repetitive work that must be done prior to the code review, authorization, and application status checks can also be done by bots using the automation procedure that permits their use. These can all be completed more quickly and accurately than by people.

3. Performance Evaluation and Data Gathering

The DME revenue process could become less effective if the person who has access to the data does not take ownership of their task or work performance. As a result, make sure that everyone on your team is continually coordinating and understanding who has access to what information and who is responsible for what performance. The accuracy of the alignment can be checked utilizing technology like tracking and reporting metrics.

There may be instances where claims are refused and denied. To be able to resubmit and modify them, it is essential to first understand the distinction between the two. Rejecting a claim is frequently like giving up; the account must be modified or appealed. On the other hand, there is still hope for claim denials where the payer needs to provide further information, authorization, or code updates. Within 24 hours of receipt, the problem must be resolved, whether such a claim is rejected or refused. The more quickly it is examined, the more likely it is that the claims will be paid.

By organizing and maybe even outsourcing DME billing as well as complaints management processes, you can increase the effectiveness of your DME services and enable a much more efficient A/R collection procedure. To keep the RCM process lucrative, you must make sure payments are being made. You also avoid the hassle of having to train your workers, which lowers your overall operating costs. When you can concentrate on the patient while leaving the DME billing and coding to an offshore medical billing company like Info Hub, you will have a better RCM, which will result in an improved patient experience.

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Enhance Your DME Billing with An Offshore Medical Billing Partner https://infohubservices.com/blog/enhance-your-dme-billing-with-an-offshore-medical-billing-partner/ Tue, 09 Aug 2022 10:48:19 +0000 https://infohubservices.com/?p=46789 DME billing is complicated and in absence of quality and knowledgeable billers, you can face revenue losses. If they do not hire seasoned billers and coders to assist them, anyone trying to manage a complex industry like DME billing will find it challenging. In order to get compensation, several steps must be taken, such as validating the patient, getting advance authorization, filing claims with appropriate documents, etc.

In addition to the other abilities, it demands a complete understanding of the reimbursement requirements for all services provided. They do not create a thorough treatment plan, which is one of the other main barriers to securing DME reimbursement. They would require the doctor’s permission, and it would only cost a part of the procedure. When it comes to successful DME billing and fair reimbursement, medical practitioners have a lot to consider.

Improve DME Billing with Offshore Medical Billing Services

So, what are the benefits of working with an offshore medical billing partner for your DME billing? Because they are experts with teams of professional medical billers and coders who have in-depth understanding of the documentation requirements for DME, outsourcing the process makes it easier in the long run.

The billers and coders would also provide consistently high-quality services regardless of market swings like modifications to the paperwork or regulations governing reimbursement, etc. They would also help with complete reimbursement for executive actions. From figuring out whether insurances are eligible for reimbursement to preparing and timely filing claims, outsourcing services provide all information. Carriers that handle DME billing outsourcing take care of claims, including the necessary coding, filing them, and following up with insurance companies to make sure you get paid on schedule. Additionally, it frees you and your staff from worrying about billing or collection concerns so that you may concentrate on the urgent medical tasks at hand. To prevent claim denials, they work on all essential procedures and software. They also make sure that the billing procedure is simplified for you.

How can DME Offshore Medical Billing Partners Help?

If billing operations are not conducted in an appropriate manner, claims can be postponed or completely rejected. It can be costly and complex to return claims, preventing the business from making money. DME billing businesses provide knowledge at each stage of the procedure, decreasing claim denials and assuring prompt reimbursements. Here are some ways how DME providers can benefit from offshore medical billing partners.

Reliability – When it comes to receiving payment, the accuracy of the invoice takes center stage. Payers’ experience financial strain when invoices and supporting papers are missing certain services, which is why it’s crucial to create bills with the highest level of preciseness and thoroughness. Your claims are electronically submitted by offshore billing businesses using a secure system with full internal billing control.

Certified Specialists – To assist you with your DME billing and coding, certified professionals are available from offshore DME billing companies. You can be sure that there will be few to no billing problems because the team is hired following thorough training and interviews.

Cost-Effective – By giving you access to expert services, technology and software, offshoring your medical billing can lower overhead expenses and boost earnings.

HIPAA Compliant – You can be assured that all of the sensitive data handled by the agencies is always kept safe and secure because all DME billing systems of the offshore medical billing company are HIPAA compliant.

Modern Technology – The most recent versions of the best DME billing software are used by the majority of billing organizations. They can help you sign up your practice for any new software that fits your requirements.

Info Hub, an offshore medical billing and coding company comes with expertise in DME medical billing srvices. We have worked hard to establish ourselves as a technology-driven business with all of the most recent electronic billing and verification systems in place, as well as a partner agency you can work with to guarantee your goals are met in the most efficient manner. We provide total transparency and constant access to your financial records with our specialized teams for claim submission, payment follow-up, and producing bespoke reports. Our billers and coders are skilled with the finer points of the procedure, and are always up to date on the most recent DME billing rules. In today’s complicated and expanding healthcare industry, effective DME billing and coding administration has demonstrated to be a strategic benefit for doctors.

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How is DME Billing Different from Other Medical Billing? https://infohubservices.com/blog/how-is-dme-billing-different-from-other-medical-billing/ Tue, 19 Jul 2022 12:00:39 +0000 https://infohubservices.com/?p=46627 What is DME?

Durable medical equipment (DME) is what’s needed to support a medical need. DMEs include wheelchairs, special accessories, oxygen tanks, hospital beds, ambulatory aids, and more. When a doctor recommends an extreme medical necessity for utilising any of these things, the majority of health insurance companies, along with Medicare, describe these as DME benefits. Before any suggested item can be delivered or installed, a home evaluation is required for DME or durable medical equipment billing to ensure that the proper safety regulations are met in the specific home.

Durable medical equipment comes in a huge variety and is typically very expensive. As a result, renting them as opposed to buying them is common. Accordingly, there are variations in the DME billing procedure, particularly in the medical codes that are used in the claim.

How is DME Billing Different from Other Medical Billing?

Additionally, medical billing firmly mandates that all claims be backed by records and declarations proving the absolute necessity of using the item or equipment, unlike other popular kinds of therapy like prescription medication, infusions, or surgery. In other words, the payor must be entirely convinced that the DME provided is actually and unquestionably required for the patient to cure (or help with) their disease.

In order to ensure that each claim is processed promptly and that the payment is made, the provider must diligently monitor every claim they submit to the payor. Naturally, this also assumes that the claim is filed within the required timeline, that all required evidence has been provided, as requested by the payor, that all coding has been completed thoroughly and accurately, and that any denials or rejections, if any, have been resolved.

Understanding DME Billing

DME billing businesses demand that receivers adhere to all usage, operating, and maintenance guidelines. They must seek assistance to make things right if they have any operational failures. It is also necessary to provide users and attendants with the proper instructions on how to track and report changes in patients’ medical conditions, as well as professional assistance in determining whether a given DME comes under insurance coverage.

The numerous standards and regulations of various payors are frequently too demanding or difficult for healthcare practitioners to maintain compliance with, especially with DME billing. The time and money allotted to such back-office operations are largely consumed by duties that are characteristic to DME billing, such as confirming the patient’s eligibility, securing prior authorisation, entering the necessary HCPCS Level II codes, and monitoring the status of submitted claims.

Outsourcing DME Billing

The extent of expenditure, time and effort incurred in DME billing is the main reason why so many providers choose to outsource DME billing services. Many of these companies are offshore and offer outstanding support with very clear cost, time, and productivity advantages.

Outsourcing DME billing services to a knowledgeable and experienced billing agency can help save operational expenses, increase productivity, decrease denials, and eventually increase collections—benefits that no demanding DME provider can really ignore. Info Hub, an offshore medical billing service company is adept with DME billing requirements, and offers its expertise to DME providers in order to keep their revenue growing and profitable. Our team can handle your DME billing that will give you fewer rejections and increase your revenue, while you focus on the needs of the patients.

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How To Implement a Positive HME Billing Strategy? https://infohubservices.com/blog/how-to-implement-a-positive-hme-billing-strategy/ Wed, 13 Jul 2022 10:54:15 +0000 https://infohubservices.com/?p=46618 Successful HME companies have to overcome obstacles like cutbacks in reimbursements, growing employment costs, and competitive bidding, all of which put additional strain on their billing departments. This often results in backlog increase.

If you are having trouble managing your HME billing, tying with someone who is aware of your overall needs in terms of your revenue cycle will be your best option. What your HME really needs is a diligent partner who can maximise your reimbursements to the fullest extent. Outsourcing seems like a feasible option for when you are facing such hurdles and are looking at implementing a positive HME billing strategy

Many HME providers are aware that technology can benefit their company. You can be missing out on new, fast developing technology that might help increase sales, expand your business, and enhance your referral network. The most recent innovations achieve all of this by emphasising business efficiency and operations expansion, the two areas where many HMEs struggle to be successful.

Effective Billing Strategy with Outsourcing

It’s a common misconception among those who are wary of HME billing outsourcing that outside partners can only do straightforward duties like invoicing and collections; this is far from truth. A reliable HME partner can actually assist in delivering high-quality services in each of the following areas, and eventually assist in growing revenue for your business.

  • Order Intake – Filling new orders includes everything from managing incoming referrals received through fax, web portal or email, to entering patient and order-related data. Additionally, eligibility must be checked in order to confirm that patients are eligible for coverage.
  • Billing and collections – These procedures ensure that prescriptions and new orders have been filled correctly. The billing and collections division controls denials and open A/R balances, evaluates billing, enables claims transmission, and maintains front-end rejections.
  • Prior Authorization – This stage comprises gathering health information and other crucial data, and sending it to payors by web portal, fax, or phone.
  • Cash Posting: Cash posting reconciles bank deposits and EOBs and ERNs. Additionally, changes, denials, and payments are applied to the A/R balances in this area.
  • Eligibility Verification (EV) – EV entails obtaining information about a payer’s financial responsibilities through payer websites, payment systems, and phone calls. This part influences whether patients’ deductibles are fulfilled, and whether doctors are within the network or not.  It also looks at how patients can benefit, and who is responsible for paying for orders.
  • Resupply management encompasses many facets of a provider’s resupply operations, from patient engagement to the completion of orders, and it makes sure that this important source of income is prioritised.

Managing HME Audits

Pre and post payment audits are becoming more common for HME organisations, which can be both, stressful and expensive. An audit request can lead to a slowdown, and put your organisation at risk financially if you don’t have a solid strategy and technological platform for keeping correct and retrievable data.

The most recent esMD standards should be used to submit audit reports in addition to automatically locating the appropriate documents and adding them to each claim. Beyond increasing productivity, the correct technology can assist providers in maintaining a healthy cash flow by promptly and accurately addressing audits.

Over the past few years, Info Hub has earned the trust of some of the biggest suppliers by offering HME billing services. With our resources, we can provide comprehensive medical billing and coding services that will completely eradicate any chance of a ROI.

We have a great team in place that reduces costs with our regular presence by over 80%. We believe in the fact that you need someone to deliver everything under one roof so you can focus on other important facets of your business. Our team at Info Hub is aware of what is necessary to boost revenues and reimbursements.

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DME Billing done easy with Outsourcing https://infohubservices.com/blog/dme-billing-done-easy-with-outsourcing/ Tue, 17 May 2022 13:09:35 +0000 https://infohubservices.com/?p=45847 Executing medical billing services for a complex practice like DME (durable medical equipment) will be difficult for anyone to do unless they hire experienced billers and coders to help them. The process of securing payments is complicated by a number of factors, including patient validation, acquiring authorization in advance, using the necessary forms to file claims, and so on.

Aside from the other skills, it necessitates a thorough awareness of the reimbursement standards for all services rendered. Some of the other major roadblocks to receiving DME reimbursement are that they do not construct a comprehensive treatment plan. It would only cost a portion of the operation, and they would need the doctor’s approval. Medical providers have a lot to look out for when it comes to successful DME billing services and fair reimbursement, which may be time and money consuming.

Challenges in DME Billing

It is important to understand the challenges in DME billing in order to understand the advantages of outsourcing the process. Here are the most common challenges faced by DME providers –

  1. Services are not covered by Medicare or Medicaid health insurance plans
  2. In the Healthcare Common Procedure Coding System (HCPCS), that depicts level II codes issued to DME gear and supplies, there is a lack of sufficient foundation.
  3. These may be considered as therapeutic services

How Outsourcing Makes DME Billing Easy?

So, what are the benefits of outsourcing DME billing services? You make it easier in the long run by outsourcing the process because they are professionals with teams of professional billers and coders that have extensive knowledge of the paperwork needs for DME.

The billers and coders would also to deliver consistent quality services regardless of industry fluctuations such as changes in reimbursement rules, papers, and so on, and would aid with full reimbursement for executive actions. Outsourcing services give all information, from determining whether insurances are accessible for reimbursement to drafting and filing claims on time.

DME billing outsourcing companies handle claims, including proper codes, submit them, and follow up with insurance companies to guarantee that you are reimbursed on time. It also allows you and your personnel to focus on the vital medical operations at hand without having to worry about billing or collection issues. They work on all of the necessary processes and software complications to avoid claim denials, and also ensure that the billing process is streamlined for you.

How can DME Billing Partners Help?

If billing functions are handled incorrectly, claims may be delayed or denied entirely. Returning claims can be expensive and time-consuming. It may obstruct the company’s ability to generate income. DME billing companies offer expertise in every stage of the process, ensuring reducing claim denials and timely reimbursements that help in the overall profits of your business. Here are a few benefits –

  1. Reliability – When it comes to getting paid, the focus shifts to the invoice accuracy. It becomes a financial strain for payers when invoices and accompanying documents lack specific services, which is why it is critical to prepare bills with the greatest level of correctness and comprehensiveness. Outsourced billing companies submit your claims electronically through a secure system with complete internal billing control.
  2. Certified Professionals – Outsourced DME billing providers come with certified professionals to help you with your DME billing and coding. They are hired after extensive training and interviewing; thus, you can be assured of minimal to no errors in the billing process.
  3. Cost-Effective – Outsourcing your billing can reduce overhead costs and increase profits by providing access to professional services, technology and software.
  4. HIPAA Compliant – All DME billing systems are HIPAA compliant, so you can be certain that all of the sensitive information handled by the agencies is kept safe and secure at all times.
  5. Latest Technology – Most billing companies use the most up-to-date versions of the top DME billing software. They can assist you with enrolling your practice in any new software that meets your needs.

Info Hub Services, an offshore medical billing and coding agency comes with a long experience in DME billing. Our efforts have resulted in us becoming not only a technology-driven company that has implemented all of the most up-to-date electronic billing and verification tools, but also an agency you can collaborate with to ensure your expectations are met in the most effective way possible. With our dedicated teams for claim submission, payment follow-up and creating customized reports, we offer complete transparency and 24/7 access to your financial reports. Our billers and coders are constantly updated with latest information on DME billing regulations, and are adept with the nitty-gritties of the process. Successful DME billing and coding administration has proven to be a strategic advantage for doctors in today’s complex and growing healthcare economy.

Still have questions about how outsourcing DME billing services might help avoid stress? Call us at +1 (888) 694-8634 or email us at inquiry@infohubservices to learn more.

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Importance of Modifiers in DME Billing https://infohubservices.com/blog/importance-of-modifiers-in-dme-billing/ Fri, 25 Mar 2022 12:44:49 +0000 https://infohubservices.com/?p=45563 Because DME billing and coding involves patients’ Durable Medical Equipment, it differs from conventional coding systems, making it a foundation of all DME billing and coding. Although not all HCPCS codes require the addition of a modifier, the majority of them do. In general, a modifier indicates whether the item is new, used, or rented on a capped basis, and only modifiers indicate which month’s DME bill is being billed when it comes to capped rentals. Incorrectly specifying these modifiers can result in claim rejection or denial. One of the most important aspects of medical coding is modifiers. It encapsulates the entire procedure’s approach, as well as the code, and allows for a smooth revenue flow.

The medical, diagnostic, and surgical operations will not be fully represented by the Current Procedure Terminology (CPT) codes. Modifiers should be added without fail in this scenario to provide accurate and full medical billing services. A CPT modifier is a code that a healthcare provider uses to indicate that a procedure or service has been modified in some way. Medical billers and physicians must understand the critical impact and importance of modifiers in DME billing.

Importance of Modifiers in DME Billing

Modifiers are important in coding because they are used in the processing of medical claims. As a result, when using modifiers in the medical billing and coding process, healthcare facilities and providers must take extra precautions. If they fail, there could be substantial consequences in terms of payment.

  1. Modifiers explain to insurance payers whether the provider’s services had a technical component, a professional component, or a combination of both.
  2. They specify if more than one physician was involved in rendering a particular service or procedure. If a service was performed in more than one location, it is clearly indicated.
  3. Modifiers also clarify if a service was performed completely or partially, and if an optional extra service was provided, it is clearly indicated.

As a result, modifiers play a crucial role in determining the correctness of medical billing and coding. What are modifiers in general, and why are they so critical in the medical billing and coding process?

  1. CPT modifiers are used to describe why a procedure was conducted as well as to specify where on the body the procedure was performed. The information, on the other hand, contains the number of procedures performed, the number of healthcare professionals or surgeons engaged, whether any additional services were performed, and whether any odd events occurred. CPT modifiers are two-character numeric codes. They can, however, be alphanumeric in a few circumstances. They also use a hyphen at the end of the CPT codes.
  2. The American Medical Association has a wealth of CPT coding information, including a large number of accessible codes and complex guidelines for applying modifiers.

In DME billing and coding, there are multiple modifiers in the line that are used for various purposes. Because these are difficult to recall, it is recommended that DME coding and billing services be outsourced. Because knowing these modifiers and how to utilise them is so important, healthcare providers should learn more about them before employing them. Many organisations, such as Info Hub that provide DME medical billing services offer experienced, comprehensive billing in order to process claims quickly and accurately. We are a leading offshore medical billing and coding services agency with immense experience in DME billing, ensuring you get paid for every service offered.

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Can Outsourcing DME Billing Services To India Help Providers? https://infohubservices.com/blog/can-outsourcing-dme-billing-services-to-india-help-providers/ https://infohubservices.com/blog/can-outsourcing-dme-billing-services-to-india-help-providers/#respond Fri, 11 Mar 2022 11:36:12 +0000 https://infohubservices.com/?p=45484 As the healthcare industry evolves, it is certain that regulations and policies will continue to add to the current system, causing healthcare companies and practises to look for more efficient ways to run their businesses.

Are you finding it difficult to keep up with the changing DME billing landscape as a result of legislators’ new regulations?

The successful management of medical billing, medical coding, and revenue management is a strategic objective for the sector in today’s complex healthcare market. The DME billing procedure is distinct from conventional medical billing and coding procedures. DME equipment is classified under HCPCS level II codes, which differs from standard coding. These codes are 5 digits long and made up of a mix of letters and numbers. Following these difficult codes while performing the DME billing process necessitates domain-specific knowledge.

The DME billing process comprises a number of processes, beginning with obtaining a prescription from a physician, assigning proper codes, and submitting a billing claim to the patient’s insurance provider, before distributing the DME to the patient. Every facet of your DME business is outlined by severe federal and state rules.

Failure to follow these requirements when billing for DME services delivered could result in the insurance company not paying the full amount. The DME medical billing system is complicated, and you’ll need a professional to handle it for you if you want to run a medical practise that avoids unnecessary federal attention. Are you concerned about declining collections, the cost of training new workers in billing responsibilities, rising billing errors, and services being halted when staffing goes on leave?  If you’re continuously dealing with such issues, outsourcing DME billing services is your best bet for overcoming difficulties. Are you considering outsourcing your medical billing services to India? Let’s have a look at how and why this option can benefit you.

Exhaustive Knowledge of DME Billing Process

An extensive experience with the Healthcare Common Procedure Coding System (HCPCS), which oversees the assignment of level II codes for DME supplies and equipment is a must. Some of the quality red flags that a certified DME billing expert must not display, include improper application of the seventh figure for trauma and fracture codes, as well as inappropriate procedure code usages. Claims denials come from improper use of codes, which is a huge blow for a company’s revenue collection ambitions.

Time Difference Being an Advantage

Indian standard time is around 6 to 12 hours ahead of western time zones. Because most of your billing operations will be completed way before the turnaround time, the time difference is an additional benefit to outsourcing medical billing services to India.

Back-Up Plans in Place

The healthcare administration management will continue to be clouded by uncertainty. Businesses will confront manpower scarcity, jeopardizing timely and accurate execution of the DME billing process. In this situation, it’s critical for businesses to check whether DME billing service providers are using redundancy strategies. Redundancy plans will be used by providers with the future in mind to ensure that DME billing operations such as eligibility assessment, authorization, AR collections, and denials are completed on time.

Strong Reporting Process

It is critical for healthcare organisations to work with DME billing service providers that can assist in lowering overall operational costs. An expert partner should be able to give reliable reporting that identifies areas for improvement in the DME billing process, reducing billing errors and improving the chances of saving money by completing the work in one go.

Save Overhead Costs

Medical billing services can be outsourced to save money, which is why many practices opt for it. Training, staffing, infrastructure, investments, and healthcare IT services can all be cut. Outsourcing services can also improve the efficiency and consistency of revenue collection and cash flow processes.

Efficient Management

It is true that focusing on administration and patient care at the same time is difficult for practises and businesses. Redirecting difficult administrative operations like medical billing management to other resources, on the other hand, might improve patient care. A stronger focus on patient care will result in higher returns for practises, as it will assist in the creation and maintenance of a successful healthcare practise with a devoted patient base.

Because we guarantee an optimal revenue cycle for your firm, Info Hub Services is a qualified outsourcing DME medical billing partner. We have our state-of-the-art IT, administrative, and storage infrastructure with a separate section for different medical specialties, keeping in mind worldwide regulations and market conditions. The following certificates are held by our employees:

  1. HIPAA Certified Professional (CHP)
  2. HIPAA Certified Security Compliance Specialist (CSCS)
  3. HIPAA Certified Administrator (CHA)

Info Hub’s experienced DME billing and coding professionals keep an eye on eliminating billing errors, smoothing cash flows by achieving greater economies of scale, and providing advice on difficult claim circumstances with perfect understanding. We offer healthcare organisations the results they are looking for.

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3 Most Common DME Billing Challenges https://infohubservices.com/blog/3-common-dme-billing-challenges/ https://infohubservices.com/blog/3-common-dme-billing-challenges/#respond Wed, 23 Feb 2022 09:16:01 +0000 https://infohubservices.com/?p=45134 DME billing is complex, and Info Hub, a leading offshore DME billing company in India comes with the required expertise to help increase your revenue. Efficiency is the key to success in any healthcare setting! Your ability to innovate and improve patient experience while lowering costs and minimizing mistakes is critical to your success. To fulfil these objectives, it is critical to have a well-functioning medical billing system in place. With our DME billing services, we leverage our experience, expertise, and latest technology to ensure complete accuracy and competence.

The Durable Medical Equipment (DME) billing sector is continually evolving due to the ever-changing regulatory compliance. Most organizations find it difficult to keep up with the changing DME billing market, which is why offshore DME billing services are a lucrative option. Medical equipment companies confront a variety of issues, including declining collections, billing errors, the cost of training new employees, and operations that are halted due to a lack of personnel. Understanding the various issues that make up a part of DME billing can help reduce these, and have increased returns. Read on below for the most common DME billing challenges.

Policy Violations

When invoicing or payment for services is not in accordance with the written policy, it is considered a policy violation. DME claims sent to Medicaid rather than Medicare or another primary insurance plan. Medicaid is considered the payer of last resort, so payment should be sought from other insurance first.

Coding Errors

Errors in code are another major cause. The claim will be refused if your billing team submits medical documentation with different codes than the ones billed. Typical coding related challenges are –

  1. Using HCPCS codes incorrectly to drive a diagnostic related group (DRG)
  2. For trauma and fracture diagnosis codes, the seventh character is incorrectly applied
  3. Respiratory failure is misdiagnosed
  4. Using guidance tools incorrectly
  5. Inadequate documentation of devices, components, grafting materials, etc

Insufficient Documentation

When a provider’s documentation does not fully support the billed procedure code, it comes under the insufficient documentation error. Common DME claim documentation errors include:

  1. Medical Necessity – It is critical that the evidence demonstrates the treatments billed were medically necessary under Medicare’s coverage and payment policies.
  2. Use of Modifiers – Incorrectly employed modifiers for DME billing can result in claims being denied or rejected. Even a misplaced code can result in a claim denial.
  3. Verification of Patient Data – A common factor is a lack of patient data verification. Claims are denied by the CMS or the insurance provider if there are minor errors in names, or the way forms are filled out.

Without adequate documentation, coders and billers will struggle to enter the relevant information, resulting in claim denials. And, when paperwork is insufficient to support the claim, healthcare professionals not only lose the money, but also the time and effort they put into it.

Ways to Reduce DME Billing Errors

To fix the majority of the faults discovered, there are certain potential practices that can be adopted into everyday billing.

Quality control on services

  1. Verify the equipment or supplies provided are in accordance with documented policy.
  2. Verify the delivery of equipment or supplies is in line with beneficiary or representative signature.
  3. Verify that the completion of environmental modification is completed with beneficiary or representative signature.

Quality control on beneficiary records

  1. Confirm if beneficiary has other insurance as a major payer
  2. Determine a beneficiary identifier on each document.
  3. Double-check the documentation accurately so it reflects the type of DME and quantity delivered.
  4. Check the quantity of units billed as part of the claims processing quality control.
  5. Confirm the procedure or service code is correct, along with the service dates entered on the documentation.
  6. Ensure the claim’s number of units and product description match the documentation’s number of units and product description.

Having a sound team of billers and coders who are familiar with CMS guidelines and regulations can help in timely and accurate DME claims. Offshore DME billing services have the required resources at disposal and are responsible for a knock in profits if they use incorrectly coded modifiers. Given the difficulties and complexities of DME billing, many providers opt for offshore DME billing companies. By offshoring their billing, they gain access to a team of highly trained coders and billers that are dedicated to delivering timely payments, minimized errors and increased collections.

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End-to-End Guide For DME Billing Services https://infohubservices.com/blog/end-to-end-guide-for-dme-billing-services/ https://infohubservices.com/blog/end-to-end-guide-for-dme-billing-services/#respond Thu, 27 Jan 2022 08:23:48 +0000 https://infohubservices.com/?p=44941

Durable Medical Equipment or DME has undergone regular renovations over the years due to changes in regulatory compliance. Constantly changing the DME billing landscape always creates so many challenges for the medical equipment suppliers and medical practitioners. DME contributes to approximately 2% of Medicare’s annual expenditure. Then denials are some of the stressful reasons for healthcare professionals while billing Durable Medical Equipment.

Not all DME billing claims will return proper revenue reimbursements for healthcare professionals. DME billing has the maximum denials than any other field in the healthcare services. Its due to various reasons and factors but all these denials cause major damage for revenue payments in the revenue cycle management process.

Some other concerns faced by DME providers, such as fewer collections, billing errors, training expenditure for new staff, discontinued operations in the absence of office staff. DME billing needs proper attention and concentration. Even the smallest mistake can lead to very slow productivity and revenue halt.

What is DME billing?

  1. Durable Medical Equipment is therapeutic equipment prescribed by a licensed healthcare practitioner to patients suffering from certain medical conditions.
  2. DME billing covers only if the equipment is used for prescribed medical conditions and not for convenience and beyond reasonable requirements of the patient.
  3. Examples for DME are Nebulizers, Ventilators, Kidney machines, etc. DMEs are mostly meant for therapeutic benefits for those patients suffering from chronic conditions or long term illnesses.
  4. Yet, it may or may not be useful for patients without any chronic diseases too. DME is durable and the time period can be more depending on the sickness of the patient.

What is DME Coding?

  1. DME billing agencies, data analysts, and coding experts use a customized DME coding system that puts a track of all codes in DME billing services.
  2. DME coding helps the distributors and vendors keep track of DME billing services efficiently so that claims won’t be missed and will be fast tracked. It’s important to learn that the coding system for DME cannot be a substitute for HCPCS releases.

DME billing Services in a Gist

  1. Right after the invoice is created, it’s the most important or necessary step to pile up those documents and medical records for electronic claim submission.
  2. A deep check of the documentation is important before the electronic claim submission. The document needs to be error free and clear with complete information provided with essential details.
  3. If any documents go missing, there are denials ready to shoot healthcare professionals or if the claim falls under non-compliance.
  4. Many healthcare professionals prefer outsourcing DME billing services to prevent denials and revenue losses.
  5. Medical billing companies usually focus on the documentation and medical records to make sure the claim is ready to go for a submission.

DME Billing and Insurance Coverage Indications

  1. DME billing services can be covered if the patient has DME benefits and the equipment is prescribed by the healthcare professional for a specific long term condition, disease, or illness. The equipment has an exception to exclude in the patient benefit plan document or history.
  2. For DME billing, DME must not be consumable unless necessary for effective use of covered DME.
  3. Patients cannot use DME unless there is a severe disease illness or disability.
  4. DME must be provided or should order by healthcare professionals for outpatient use in-home settings.
  5. DME must be used only for medical purposes or medical use.

DME Billing Coverage Limitations and Exclusions

If there is one or more DME to meet the functional need, coverage benefits are applied and available only for one DME with the minimum specifications for patient requirements such as:

  1. Standard power wheelchair Vs custom wheelchair
  2. Standard bed Vs semi-electric bed Vs complete electric or floating bed

This limitation is specifically meant to eradicate coverage for deluxe or additional components for a DME item and is not much required to meet the minimal specifications of patients to treat the chronic disease or illness.

When a patient buys or rents a DME surpassing the mentioned guidelines, the patient is held responsible for the cost difference between the items or devices purchased or rented.

The DME billing services excluded from coverage include:

Accessories or devices that are included in the DME services are mainly meant for the patient’s comfort and convenience. Here are some DME devices that are not covered by insurance companies:

  1. Air conditioners
  2. Air purifiers and filters
  3. Batteries for non-medical equipment
  4. Humidifiers
  5. Non-medical mobility devices.

These exclusions are not applicable for Pediatric DME billing coverage.

Covered DME Billing Services

DME billing services or healthcare services including supplies or pharma products to decide the following:

  1. DME is provided for preventing, evaluating, diagnosing, and treatment of a chronic disease or illness, injury, mental illness, addictive disorder.
  2. DME that’s medically necessary.
  3. Not excluded and described under covered services.

We hope you now have an idea of DME billing services.

With DME billing outsourcing to Info Hub, you get to partner with a reliable offshore DME billing company that is overly focused on simplifying your billing process and assuring that you receive accurate compensation in the shortest possible time.

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Understanding The Complexity Of DME Billing https://infohubservices.com/blog/understanding-the-complexity-of-dme-billing/ https://infohubservices.com/blog/understanding-the-complexity-of-dme-billing/#respond Tue, 04 Jan 2022 12:11:21 +0000 https://infohubservices.com/?p=44890

Durable Medical Equipment (DME) billing  is one of the booming and extensive industries in today’s date. The industry is constantly evolving due to changes in compliance regulations and requirements. It can be a task if the providers don’t have an in-depth understanding, which may result in a larger number of rejected claims, lower reimbursement, and hence lower revenue.

What is DME?

DME is the medical equipment providing therapeutic benefits that can help people in need due to certain medical conditions, at home or any non-hospital setting. The DME must be medically necessary, requires a prescription, and needs to be authorized before it gets eligible for coverage. DME providers need to have a streamlined billing process for submitting and receiving claim payments from the insurance companies.

DMEPOS is a broader concept including SME medical equipment and Prosthetics, Orthotics, etc. DMEPOS equipment includes walkers, crutches, hospital beds, wheelchairs, artificial limbs, neck braces, prosthetic devices, and many more.

How is DME billing different?

Things that make DME billing different from other types of medical billing:
  1. Renting or owing equipment is allowed in DME billing and codes are specifically designated to equipment. Whereas codes are mostly designated to procedures or services in medical billing.
  2. DME billing uses HCPCS (Healthcare Common Procedure Coding System) Level II codes while medical billing uses HCPCS Level I codes generally.
  3. Modifiers are optional and won’t directly impact the claim in medical billing. Whereas the use of modifiers is mandatory and will determine if a claim will be denied or approved in DME billing.

Processes in DME Billing

The patient must have seen a specialist who has prescribed the equipment as essential. Hence, a written prescription from a medical practitioner is needed.

The patient will then go to a DME provider to get it. A Certificate of Medical Necessity should be completed and signed by the doctor and the DME provider. At this step, the patient also may need pre-authorization, which is done by the patient’s insurance company. A signed delivery slip or its photo can also be asked.

The provider contacts the insurance company to confirm and check information like which insurance the patient has and what all it covers. The patient’s insurance policy number and the group plan number are also taken.

Only after successful verification of the documents and information, the provider can generate the invoice. This is the step where each piece of the equipment is billed and coded according to the HCPCS Level II codes and modifiers. Some of the common modifiers used are RR – Rental, NU – Purchase of new equipment, UE – Purchase of used equipment.

The final step is to file the claim electronically. Claims sent to the insurance company will then be evaluated and the process may take around 30 days. If they’re rejected due to any reason, the provider needs to re-submit with corrections.

Tips for Better DME Billing

  1. DME payor medical policies change frequently and you need to stay updated with all those to run your billing smoothly.
  2. As common as it sounds, you need to have a thorough billing process from admission to submission of claims. It will ensure you get fewer denials and the maximum reimbursement for all your claims.
  3. If you’re unsure about the documents needed, you could always confirm them first with the insurance company. As the DME billing process is exhaustive, one small error in the documentation can bring you to the start again.
  4. Any patient’s record must display medical necessity always. You may check medical policies and Local Coverage Determinations (LCDs) to see what can be added as medical necessity proof.
  5. Keep reviewing the denial rates and pay extra attention to the reasons why the claims were denied. You also need to correct the errors and re-submit them to take benefit of reimbursements.
  6. Regularly audit your process so that all things are kept updated.

Outsourcing DME Billing Services can help reduce your stress as the appointed company will stay updated with the policies for you, submit all the claims, check and correct the HCPCS codes, and keep track of the rejected claims. Outsourcing saves your time and resources to develop a process, train staff with all the current regulations, and reduce your time-consuming tasks.

Info Hub is a leading offshore medical billing service provider agency and we can help you with optimizing costs for your DME billing services.

We will help in verifying eligibility, prior authorization if needed, correct use of HCPCS Level II Codes and Modifiers, submission of claims, accounts receivable and managing the denied claims.

Outsourcing DME Billing Services to India has several benefits as they’re thoroughly updated with the medical billing in the USA.

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