Durable Medical Equipment’s (DME) are therapeutic items that is prescribed by physicians to patients who suffer from a medical condition. Durable medical equipment or home medical equipment billing is complicated with already associated medical condition and need for equipment’s to maintain the health scenarios of patient.
Healthcare providers dealing with patients having preconditions that demand DME or will need DME have to mention the pre-conditions during prior-authorization to get billed. In January 2021, CMS released a DMEPOS fee schedule amount, it again released it on April 2021 with revised durable medical equipment bidding program. Legion Healthcare Solution (LHS) understands the growing concern among physicians about the bidding program resulting into revenue loss and claim denials due to use of modifiers. CMS recently was able to identify multiple calculation errors where the fee schedule amount decreased by 30 percent or increased by 57 percent.
“Modifiers use in DME billing needs to accurate and even relatable to the earlier diagnosis of the patient. Most equipment providers make an error during documentation and prior authorization leading to part payment or complete denial of the claim.”
– AR expert in DME
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