Understanding medical coverage and billing for DME

What is DME?

DME is the medical equipment that assists a person with their routine tasks at home or in any setting outside the realm of the hospital. DMEPOS products include prosthetics, supplies, and orthotics. DMEPOS equipment is used repeatedly and can last up to 3 years. These items include but are not limited to

  • Artificial limbs
  • Crutches
  • CPAP machines and equipment
  • Orthotics
  • Beds
  • Prosthetic equipment
  • Walkers
  • Wheelchairs

What is DME billing?

The submission of claims to receive payment from the insurance company to optimize Revenue Cycle Management is called DME billing. Complete training in the billing process, maintenance, and implementation are essential for any DME practice. This also entails staying updated with compliance guidelines and ensuring immaculate claims. 

Is DME different from other billings?

DME is comprised of two components: it allows rentals and utilizes Healthcare Common Procedure Coding System codes. When a practice submits claims, the medical code linked with the billable item or service given is properly stated.

How can I better understand DME?

This industry constantly evolves and thus requires consistent checks. The key is to understand the complexity of DME billing. 

  • Record-keeping

DME requires creation and maintenance for efficient billing submissions. This has a great ripple effect on the business structurDurable Medical Equipment (DME) billing is an arena with continuous policies, regulations, and compliance. You can succeed in this industry if you have a solid understanding of the DME Billing process, its critical components, and claim audits. 

e and reimburses revenue over time. 

  • Billing Guidelines

As previously stated, these guidelines frequently change or improve based on the services or product lines. It is critical to keep an eye on CMS’s website and adhere to the Medicare and Medicaid DME criteria.

  • Billing Specialist

A DME specialist will be equipped with all the necessary guidelines, knowledge, and discipline to complete the required paperwork. They are experts in claim status, follow-ups, any complications arising, and bringing in new business. 

  • Billing Companies

Many practices resort to outsourcing DME billing services, which helps them watch for policy changes and accelerate payments. This will ensure increased revenue, fewer denied claims, and timely payments. They can prove to be an extension of their practice and free the in-house staff to cater to patients and other administrative tasks. 

Conducting DME Claims Audits

Medicare DME audits and practices ensure the claims are clean and accurate. If a facility receives an audit request, it is recommended that they submit all required documents on time and review claims internally. Some of the types of Medicare DME audits include

  • Medicare Administrative Contractors Audits. 
  • Recovery Audit Contractor. 
  • Unified Program Integrity Contractors Audit. 
  • Comprehensive Error Rate Testing Audit 

Tips for Reviewing Outsourced DME Billing Companies

If you are looking to outsource a DME billing company for your practice, these are some questions to keep in mind. 

  1. How do they review their documents?
  2. How are claim denials managed and reviewed?
  3. What is their process to identify rejection trends?
  4. Can you request personalized support for your practice?
  5. Will they conduct workshops or meetings to train in-house staff?
  6. Are their staff and equipment updated with policies?


DME billing is a crucial and complicated process that requires experts on the job. With a thorough understanding of DME and its ways, a provider will be able to employ training sessions or outsource capable experts. Competent companies provide healthcare facilities with reports, reviews, and customized support. With a keen eye for detail, a practitioner can make the right choice just when their facility needs it. 

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