Durable Medical Equipment

Durable Medical Equipment (DME) is any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions and/or illnesses. DME must be found medically necessary, requires a prescription and should be authorized in advance, before it is eligible for coverage. Thus DME billing is fairly different, and more complex, from other types of medical billing and coding. It requires specialized, in-depth knowledge of all HCPCS Level II codes and the overall DME reimbursement process.

The complicated nature of this type of billing serves to be a challenge. With an increasing number of expensive medical equipment or DME being rented rather than purchased, billers and coders need to be aware of:

  • How to code claims (depending on rental vs. purchase); 
  • The requirements to bill; and
  • When to send claims for accurate and timely reimbursement. 

Our DME Billing Services

Our team of billers and coders have extensive experience and expertise in handling your DME claims effectively. We understand the industry and set you up for success right from the beginning of the revenue cycle process. Our DME billing services include:

  • Eligibility Verification & Prior Authorization  
  • Patient Demographics Entry 
  • Order Entry 
  • HCPCS Level II Coding & Modifiers 
  • Claims Submission 
  • Payment Posting
  • Accounts Receivable & Denial Management 
  • Credit Balance Resolution 

3Gen’s DME Revenue Cycle Management Process

We effectively manage your backend activities and get your claims paid on first submission, helping you collect faster.

Step 1

A medical provider has a DME requirement, which is necessary to provide specialized patient care. Documentation should be prepared to demonstrate medical necessity. We ensure overall ease of claim submission, by compiling all necessary medical review documentation to avoid any delays in the process.

Step 2

Once the provider has prescribed a specific DME, the patient is required to get their equipment from a DME supplier. Our team will verify eligibility and obtain prior authorization (if required) to approve the use of DME supplies. Once the paperwork is completed and approved, the DME supplier can provide the patient with the equipment.

Step 3

Our team then assigns the correct HCPCS Level II codes and bills the DME claims to the patient’s insurance company. We will ensure every piece and accessory of the equipment is coded for and all necessary paperwork is provided to the payer to get the DME claim paid.

Step 4

Our accounts receivable management team then follows-up on the claim to make sure accurate payments are made in time.
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