DME Billing Coverage Limitations And Exclusions

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DME Billing Coverage Limitations and Exclusions
Durable medical equipment (DME) billing is an
essential aspect of revenue cycle management in
the healthcare industry. As the industry evolves,
DME has grown in importance and now serves
millions of patients. However, managing the
billing processes and reimbursements associated
with DME can be time-consuming and
labor-intensive. DME billing is becoming more of
an administrative burden for healthcare providers
as regulatory requirements continue to grow. In
fact, the DME billing process is prone to
numerous mistakes and errors due to such
complexities. If not addressed properly, these
errors can result in claim denials or rejections,
resulting in significant losses for the DME
provider. Here are some of the most common DME
billing requirements one must be aware of to
receive the adequate reimbursement amount for the
services provided.
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DME Billing Coverage Limitations and Exclusions
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DME Billing Coverage Limitations and Exclusions
What is DME Billing? The process of generating
and submitting claims for the durable medical
equipment provided is called DME billing.
However, DME billing does not cover equipment or
devices that are used for convenience rather than
a medical need of the patient. What is DME
Coding? DME billing companies, data analysts, and
coding specialists submit insurance claims using
HCPCS (Healthcare Common Procedure Coding System)
codes. This DME coding system contains a list of
all the codes used in DME billing services. These
codes aid in the tracking of supplies and
equipment given to patients. As a result,
Medicare and other insurers can process health
insurance claims more efficiently. HCPCS code
E0639, for example, denotes a moveable patient
lift system.
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DME Billing Coverage Limitations and Exclusions
DME Billing Coverage Conditions DME billing
services can be covered only when the following
conditions are fulfilled When a patient has DME
benefits and the equipment is recommended by a
healthcare professional to treat or diagnose a
long-term disease or illness, and the equipment
is not otherwise excluded in the patient benefit
plan document or history. DME Billing Coverage
Limitations Being a DME biller, one should be
aware of various DME billing coverage
limitations. They can be as follows 1. If a
patient uses one or more DME to meet functional
needs, coverage benefits are only applicable and
available for one DME that meets the minimum
patient requirements. They are as follows Custom
wheelchair vs. standard power wheelchair Standard
vs. semi-electric vs. complete electric vs.
floating bed 2. When a patient purchases or rents
a DME that exceeds the guidelines outlined above,
the patient is responsible for the cost
difference between the items or devices purchased
or rented.
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DME Billing Coverage Limitations and Exclusions
DME Billing Coverage Exclusions DME billing
services cover all those accessories or devices
that are primarily intended for the comfort and
convenience of the patient. However, the
following DME devices are not covered by
insurance companies Air purifiers and
filters Air conditioners Non-medical equipment
batteries Humidifiers Non-medical mobility
devices. This exclusion does not apply to
coverage for Pediatric DME billing. Remodeling or
DME modification to home or vehicle to
accommodate DME or a patient condition.
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How to Streamline the DME Billing Process?
Streamlining the DME billing process can result
in higher reimbursements for your medical
practice. Outsourcing to your DME billing
partner, such as 24/7 Medical Billing Services,
is the best way to optimize your DME billing
workflow! Outsourcing DME billing operations will
allow you to benefit from the expertise of DME
billing specialists. You can stay up to date on
policy changes, payor guidelines, regulation
updates, and so on. Moreover, these professional
DME billers and coders can help you focus on your
core expertise, providing quality healthcare to
your patients. Reach our experts to know more
about our DME billing services.
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About Us
We are a medical billing company that offers
24/7 Medical Billing Services and support
physicians, hospitals, medical institutions and
group practices with our end to end medical
billing solutions. We help you earn more revenue
with our quick and affordable services. Our
customized Revenue Cycle Management (RCM)
solutions allow physicians to attract additional
revenue and reduce administrative burden or
losses.
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Contact Us
Media Contact 24/7 Medical Billing
Services Georgia 3001 Greenfield Drive, Marietta
GA Ohio 28405 Osborn Road, Cleveland, OH
4414030068 Texas 2028 E Ben White Blvd,
240-1030 Austin TX, 78741 Delaware 16192
Coastal Highway, Lewes, Delaware 19958, United
States Phone no / Fax [phone]
Email us info_at_247medicalbillin
gservices.com
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