3 Most Unique Challenges with DME Billings - Info Hub Consultancy
DME Billings

3 Most Unique Challenges with DME Billings

The need for durable medical equipment is seeing an increase owing to the changing environmental factors, lifestyle habits, need for convenient and less dependable modes of support systems. While the demand for DME rises, so do the complexities in DME billing. The reimbursements have already been taking a hit, and the complex billing process seems not promising either.


What is DME Billing?

Durable medical equipment, or DME, is a type of therapeutic equipment that is recommended to patients with specific medical conditions by trained healthcare professionals. If the equipment is utilized for convenience or in ways that go beyond the patient’s reasonable medical needs, DME billings does not apply.


With the ever-changing regulatory compliance systems, DME billing is evolving as well, and what your organization needs the most is efficient medical billers and coders who will ensure full reimbursement. Being aware of the many issues and challenges that plague DME billing will help mitigate these. Here are the top most DME billing challenges that are unique to the specialty.


A) Irregular Billings

DME providers frequently struggle with timely billing, which limits revenue flows. Many attempts to take shortcuts to make up for the shortcomings as a result. But over time, rather than raising money, it creates more difficulties. The pressure on the collection rate rises sharply as denials mount and management fails to follow up. It causes additional issues, such as how to avoid them. Without adequate management, a lack of data for analytics causes billing to lag, and the processing of denials to deteriorate.


B) Regulatory Challenges 

Like other medical billing services, DME billings are frequently subject to legislative changes. DME providers frequently neglect to keep up with these most recent modifications and follow the new laws and regulations as a result. This eventually has an impact on how DME bills, and how much is paid out for the services. It is significant to highlight that the regulatory framework for DMEs is more intricate and stringent, which frequently puts service providers in a challenging position concerning Medicaid and Medicare Services.


C) Insufficient Documentation

The insufficient documentation issue occurs when a provider’s supporting documentation falls short of fully supporting the billable procedure code. Common mistakes in DME claim documentation include:

  1. Medical Necessity – The documentation must show that, in accordance with Medicare’s coverage and payment policies, the treatments charged were medically required.
  2. Use of Modifiers: When DME billing modifiers are used incorrectly, claims may be rejected or denied. Even an incorrect code might lead to the denial of a claim.
  3. Patient data verification – This is a typical factor that needs to be addressed. If there are few typographical or form-filling errors, the CMS or the insurance company may reject a claim.


Additional issues that DME providers face include lower collections, billing mistakes, higher training costs for new hires, and operations that are halted in the absence of office employees. DME billing services need to be handled carefully. Even the smallest error can accumulate and cause extremely poor productivity and a halt in revenue.


Why Partner with Info Hub Consultancy Services (ICS)?

Timely and correct DME claims might benefit from having a solid staff of billers and coders who are conversant with CMS Guidelines and Regulations. ICS, offshore DME billing providers are capable of using the necessary resources, but they risk losing money if they use poorly coded modifiers. Many providers choose to work with offshore DME billing companies because of the challenges and complexity of DME billing. By moving their billing overseas, companies have access to a group of expert coders and billers that work hard to ensure timely payments. Here is what we offer –

  • Cost Optimization 

In order to achieve the greatest results, we constantly innovate the DME structure. In order to keep up with the evolving business environment, we streamline the client’s current operations. To help the client reduce operating costs, we use technology and business information to boost personnel throughput.


  • Enhanced Customer Experience

Customer experience is crucial to DME medical billing services, therefore we aid our medical clients by providing them with unique solutions to provide patients, account managers, and clinics with unrivaled support. We automate the majority of the time-consuming duties for the team so that they can concentrate on the ones that require human involvement.


  • Risk Mitigation

We ensure the confidentiality of sensitive customer information and corporate data as a certified DME specialist. We are a HIPAA-compliant business with the necessary security setup to carry out DME medical billing operations and guarantee data protection. We assist our clients in avoiding non-compliance fines so they don’t have to spend money on pricey billing solutions.