Requirements for DME Billing

Requirements for DME Billing

The billing for durable medical equipment business is highly regulated and scrutinized. So it demands careful consideration when filing claims for reimbursement from Medicare and other insurance companies. The Centres for Medicare and Medicaid Services (CMS) provide DME documentation rules and instructions to assist DME providers in maintaining claim records.

Understanding and adhering to these guidelines will increase the likelihood that filed claims will be approved and paid on schedule. It also guarantees that all of your claims comply with the paperwork requirements if you are audited.

What are the Durable Medical Equipment Documentation Guidelines?

The primary goal of the documentation requirements is to provide a paper trail that supports the person’s need for the DME goods due to a medical necessity.

The relevant justifications for the supplies must be included in all supporting documentation, including prescriptions, clinical records, and documents proving prior permission. The vital information about the paperwork requirements is provided in the paragraphs that follow.

Use the available documentation checklists

To keep your employees on track with the necessary papers and facilitate a seamless billing process. There are several DME documentation checklists available. The documentation you need to gather to guarantee payment and keep that payment is included in this exhaustive checklist (in the event of an audit).

Standards for DME documentation and claim audits

The goal of Medicare DME audit evaluations is to confirm that the patient’s need for the products is justified medically. There are several audit kinds, and each one examines various aspects of your organization.

The following information explains some of the most typical Medicare DME audits.

Medicare Administration Contractors are subject to Comprehensive Error Rate Testing (CERT) audits (MACs) Unified Program Integrity Contractors (UPIC) Recovery Audit Contractor (RAC) (UPIC) Audit

Basic Requirements for Physician DME Documentation

The physician’s paperwork must be sent to Medicare and other insurance providers to satisfy the medical necessity standards. Please remember to submit all claims with the following information from the physician as part of the documentation requirement.

Patient outcomes and benefits from utilizing DME products

To demonstrate medical necessity, consider the patient’s clinical and functional state.

Health history of the patient

Treatment strategy of a qualified provider

The medical history of the patient is important

The patient’s medical record is one of the key components need to guarantee claim payment. The extra papers that strengthen the DME provider’s case and demonstrate the patient’s necessity for the DME supplies must be supported by the patient’s medical history.

Documents Needed for Medical DME

DME providers have access to a wealth of tools that can guide them in producing accurate and convincing medical record documentation. There are situations when sending the relevant paperwork with a claim is not necessary for reimbursement. It’s crucial to remember that such documents are still required. In the case of an audit, you will have to provide paperwork to support medical necessity, needed supplier standards, and appropriate payer contractual papers.

How to prevent mistakes in medical DME documentation?

Here are some useful pointers for preventing mistakes in medical paperwork.

  • Use Provider Compliance Resources to learn about typical coverage, coding, and billing problems.
  • If any DME requires a written order before product delivery, check Healthcare Common Procedure Coding System (HCPCS) for this requirement.
  • All written orders must include the doctor’s National Provider Identifier (NPI).
  • Verify that the ordering physician is a current Medicare beneficiary as of the DME service date.