Durable Medical Equipment

Navigate your DME billing challenges and enhance revenue by outsourcing to QB.

Durable Medical Equipment (DME) refers to medical devices that provide therapeutic benefits to patients with specific medical conditions or illnesses. To qualify for coverage, DME must be deemed medically necessary, require a prescription, and often needs prior authorization before it can be reimbursed. Due to these requirements, DME billing is more intricate compared to other types of medical billing and coding, requiring specialized knowledge of HCPCS Level II codes and a thorough understanding of the DME reimbursement process.

The complexity of DME billing can be a significant challenge. With an increasing trend of renting rather than purchasing costly equipment, it’s essential for billers and coders to understand the following:

  • How to correctly code claims (based on rental vs. purchase)
  • The requirements necessary for proper billing
  • When to submit claims to ensure timely and accurate reimbursement

Our DME Billing Services

QB’s team of skilled billers and coders have deep expertise in handling DME claims with precision. We know the industry inside and out, setting your practice up for success right from the start of the revenue cycle. Our comprehensive DME billing services include:

  • Eligibility Verification & Prior Authorization: Ensuring all necessary
    approvals are in place before submission.
  • Patient Demographics Entry: Accurate data entry for smooth claims processing.
  • Order Entry: Capturing all necessary details for each DME order.
  • HCPCS Level II Coding & Modifiers: Ensuring accurate coding for all DME
    items and accessories.
  • Claims Submission: Timely and accurate submission to payers for
    reimbursement.
  • Payment Posting: Proper tracking and posting of payments as they are received.
  • Accounts Receivable & Denial Management: Effective follow-up on claims to
    ensure timely payment.
  • Credit Balance Resolution: Identifying and addressing any credit balances.

QB’s DME Revenue Cycle Management Process

We handle the backend processes and ensure that your claims are paid promptly on the first submission, speeding up collections

Step 1

When a medical provider prescribes DME for a patient, documentation is prepared to demonstrate medical necessity. We streamline the claim submission process by ensuring all necessary medical review documentation is compiled to avoid any delays.

Step 2

After the provider prescribes the required DME, the patient obtains the equipment from a DME supplier. Our team will verify insurance eligibility and obtain prior authorization (if needed) to approve the use of the equipment. Once all documentation is in place, the DME supplier can provide the patient with the equipment.

Step 3

Our team will then assign the correct HCPCS Level II codes and submit the DME claims to the patient’s insurance company. We ensure that every piece and accessory of the equipment is properly coded and that all required paperwork is submitted to the payer for reimbursement.

Step 4

Our accounts receivable management team follows up to ensure that payments are processed accurately and in a timely manner, securing prompt reimbursement for your practice.

At QB, we are committed to streamlining your DME billing process, reducing the burden on your team, and optimizing your revenue cycle.

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