Wheel chairs, walkers, and crutches relate to durable medical equipment (DME) billing category and require certain procedures to follow before and during billing. Most of the insurance providers may not cover DME supplies under any policy. Even Medicare covers only some equipment, which do not come under mobility, only on periodic circumstances. Yet, there are companies that provide coverage for DME supplies like Wheel chairs, Walkers, or Crutches but with following a stringent procedure. This article can help you with providing the piece of information you need to know for billing DME supplies.
Requirements to be fulfilled for DME billing:
- To check whether your DME is eligible for coverage, you need to provide a prescription stating rent or purchase of the equipment, accordingly.
- There are certain items that you can only rent and cannot purchase. This comes under capped rentals, and based on the usage of equipment, the coverage depends as well.
- The rules may vary from one insurance provider to another. Certain companies do not encourage straight purchase of DME, but some may expect the DME to be rented first and then purchased. So depending on whom you tie-up with, follow the procedure properly.
- You should fill the CMS-1500 claim form (version 08/05) for claiming the DME bill.
- Provide the right HCPCS code to bill your relevant DME supplies. Make sure it includes but not limits to NU, RR, etc.
- Once you enter the procedure code, ensure you mention the maintenance and repair modifier codes.
- Before you submit all your claims, check whether you have provided detailed description of services provided.
- In case you do not have or find the right code for DME billing, use the code E1399 or any other miscellaneous HCPCS code. But while mentioning so, you should provide additional documentation for such DME claim if you enter miscellaneous codes.
The documentation should contain the following checklists before submitting the DME claim.
- Provide neat and complete description of DME claim you wish to proceed.
- If you are making the claim for the first time, enclose the factory invoice of the item. If it is proper, you should also get a certificate of medical necessity form duly signed by the physician. Note that you cannot include catalogues or retail price listings for additional documentation, since it cannot be accepted.
- Avoid stapling the documentation to the claim form.
- Submit all hand-written/hard copies of initial claim form to confirm that all documentation reaches for claim at a time.
- Note that additional documentation cannot be transferred if you have submitted your initial claim electronically.
Individual guidelines are available for every activity that you take up with your DME. Be it for purchase, rental, and reimbursement of DME, you should follow certain formal procedure. Before you purchase a DME, you should be aware whether it gets covered under insurance, and if so, you can keep documenting everything for the purpose of DME billing. If you opt for any DME add-ons or upgrades, it has a separate procedure for claims as well. Keep yourself updated for knowing latest changes or inclusions in the DME medical billing procedure in the future, which can avoid re submissions or mistakes while submitting the claim form.
If you have any trouble with your DME billing/claims, you can approach 24/7 Medical Billing Services and get it resolved. We offer free consultation on any process related to DME and keep you away from confused state if any. 24/7 MBS is renowned for its high-quality and reliability in providing DME billing services and successful through achieving client satisfaction across.
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