Unveiling the details of DME billing along with a brief account of durable medical equipment and a short synopsis of the history of medical revenue cycle management as related to the DME trade. Included in it are quick anecdotes of the billing cycle and its utility to the service providers, payers, and the patients.
What is Revenue Cycle Management?
The process and practice of recovering the medical expenses in form of insurance compensation as incurred by a medical service provider for the treatment of a patient from an insurance payer can be termed as RCM or Revenue Cycle Management. The process starts with the patient visiting the physician and furnishing him his insurance code, with the help of which the physician files his claim request with the respective insurance company against the treatment profile as undertaken. The payer, after due investigation of the insurability of the claim, pays for the treatment expenses much to the fulfillment of the protocol of financial exchange.
How did it emerge?
RCM has evolved as one of the principal medical billing and revenue recovery services across some of the major nations of the world, especially the United States of America. Earlier, the procedure of following the insurance protocol to recover the medical expenses used to be followed by the clerical staff of the medical service providers. However, due to lack of experience of medical claim adjudication such efforts would often yield delayed results and wastage of resources. Hence was formed an institutionalized system of formal revenue recovery as customized agencies specializing in medical billing services.DME billing is thus a part of the holistic RCM industry.
What is DME billing?
DME refers to Durable Medical Equipment, which are medical goods artificially manufactured and prescribed by the physicians for daily domestic use intended at free movement and relaxation of physical pain.
There are many organizations involved in the business of manufacture and marketing of DME products in the market who cater to private as well as large scale needs. These DME providers are in constant need of billing agencies to recover the cost incurred in supplying DME to various clients. The process of RCM for DME called DME billing entails a separate set of steps to be followed along with maintaining different statutory regulations of the insurance organizations. Various agencies follow their own ingenious ways of DME billing to meet this end. There are various challenges that confront the process of DME billing like missing information, increased denial and turnaround time, lack of adequate staff, non-compliance with protocols like secondary verification, follow-ups, correction and resubmission of claims, etc. Some of the common methods of meeting these challenges are regular transaction audit, assignment of adequate staff, proper tracking mechanism, proper submission of paper claims, etc.
An overview of a typical DME billing process as followed by companies, in general, is explained as under.
A quick overview of DME billing cycle
- Eligibility and Authorization Verification
- Patient Information Entry
- Charge Entry
- Claim Submission
- Payment Posting
- Accounts Receivable
- Denial Management
The steps explained
- Order entry based on the Rx received from the physicians
- Eligibility verification and authorization requirement entry
- Collection of documents required by the payer for auth approval
- Confirming meeting the payer criteria before the delivery of the goods
- Generation of the delivery ticket
- Creation of claim
- Submission of EDI
- Cash posting
- Rejection and denial management
- Accounts Receivable follow up
The importance of DEM billing has increased by leaps and bounds in recent times with CMS declaring a free market policy. Under that, all Medicare-enrolled DMEPOS or suppliers of DME and Orthotic and Prosthetic, both bid winners as well as non-bid winners with a proper DME billing practice in place are entitled to more and more clients.
Hence the DME billing agencies are competing with each other in practice proficiency to achieve the best results in DME billing. Healthy competition is leading to a holistic development of modern functionalities, better client communication, and impeccably accurate billing practice. This, in turn, is affecting the business domain of health care services to benevolent results to payers, providers and patients alike.